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� PgU�N <br /> �° �a SAN JOAQUIN COUNTY 16 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> GNe.-v2d.J �1-5(4 �`�N� <br /> +Facilliity adGdress: UST# <br /> G ,A � 9-9- <br /> n <br /> "product ,"11 <br /> �11 <br /> Facility Contact: Title: Phone: <br /> S www,) NMA- WAeA- <br /> .. `Monitorin Panel: Piping system: Overfill prevention: <br /> V 1'— �s $ 1 XPressurized ❑Suction ❑Gravity Mechanical ❑Audible/visual <br /> 7Ins ction type: Violations: <br /> outine Monitoring Certification ❑Installation ❑Other: ❑Ml-RDetect ❑M2-RPrev ❑M-3 Both <br /> VIOLATION(S) HSC=California Health&Safety Code;CCR=California Code of Regulations V R <br /> # Code Section V <br /> V=Violation;RV=Re eat Violation <br /> 1 HSC 25284 Permit tooperate <br /> 2 CCR 2637 Secondary containment test performed <br /> 3 CCR 2711 (b)&(c) Current Unified Program Consolidated Forms on file with EHD(Facility and tank form) <br /> 4 HSC 25292.2 Certification of financial responsibility and CFO letter ✓ <br /> 5 CCR 2632(c)(2)(D) Monitoring&response plan is current and filed with the local agency <br /> 6 CCR 2712 i Monitoring&response plan is onsite <br /> 7 CCR 2712 b Maintenance&monitoring records (Mi) <br /> 8 CCR 2643 d Daily monitoring of suction piping(pre-January, 1, 1984 <br /> 9 HSC 25292.1 UST system isoperated to prevent unauthorized release <br /> 10 CCR 2632(c)(2) UST monitoringsystem is resent Ml <br /> 11 CCR 2630(d) UST system monitoring equipment is properly located to detect a leak (Mi) <br /> 12 HSC 25291 UST system monitoring equipment isoperational M2 <br /> 13 CCR 2636(f)(1) Continuous monitoring system for underground piping&UDC is present (Mi) <br /> 14 CCR 2631 a Primarycontainment is product tight <br /> 15 HSC 25291 (a)(2 Secondar containment for UST is tight <br /> 16 CCR 2636(c)(1) All releases in secondarypiping flow to a collection sum <br /> 17 HSC 25291 f) Line leak detector(s)are installed (Mi) <br /> 18 CCR 2635 1 Spill container M2 <br /> 19 CCR 2635(b)(2 Overfill prevention system (MZ) <br /> 20 CCR 2636(a) Conventional suction piping shall have continuous monitoring&2°containment <br /> 21 HSC 25291 (e) Water in 2°containment analyzed&properly disposed of <br /> 22 CCR 2650 Recording/reportingof unauthorized releases Ml <br /> 23 CCR 2715 Designated Operator:(a)Statement from UST owner; (c-e)Monthlyinspection;(f)Em to ee training <br /> 24 CCR 2638 a Annual monitoring certification <br /> 25 CCR 2638(a) Annual line leak detector test (Ml) <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636(f)(4) Annual line tightness test (Ml) <br /> 28 CCR 2661 Repair for tank/piping has had tightness test M2 <br /> 29 CCR 2643(e) Biennial tightness test of gravity pipingre-Januar 1, 1984) <br /> 30 CCR 2643 d Triennial line test for conventional suction piping(pre-January1, 1984 Ml <br /> [36 <br /> HSC 25292.5 Double walls stem located within 1000'of public well-ELD <br /> CCR 2661 Permit to repair UST system <br /> HSC 25286(a) Permit to alter monitoringsystem <br /> HSC 25298 ) Permit to tem oraril close UST s stem HSC 25298(c) Permit to close UST s stem <br /> HSC 25299 a 9 Disablin leak detection devices <br /> HSC 25298(a) Ille al abandonment of UST s stem <br /> Other: <br /> EHD INSPECTOR: PHONE: UIC <br /> r� 2- t�t Septic system: <br /> w` V r ❑Serves>_20 people/day <br /> RV D BY: TITLE: 11 Receives other than sanitary waste <br /> Other disposal methods: <br /> Y4114NO2 ff ,fiy&0 ❑Dry wells/French Drains <br /> EHD 23-02 <br /> 1/3/07 <br />