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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton,California 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sigov.orWehd <br /> UNDERGROUND STORAGE TANK UST) PROGRAM INSPECTION REPORT <br /> FacillLy naiim : Designated Operator: 1a- Inspection Date: <br /> 1 �&]7--17 <br /> WL W <br /> Facility address: UST# , <br /> « Product <br /> Faci'ty Contact. Ti Phone: <br /> owlt 'mi, N <br /> Monitorin Panel: Piping system: Overfill prevention: <br /> ❑Pressurized uction ❑Gravity echanical Audible/visual <br /> Inspection type: Violations: <br /> outine kfmonitoringCertification ❑Installation ❑Other: ❑M1-RDetect M2-RPrev ❑M-3 Both <br /> VIOLATION(S) HSC=Califomia Health&Safety Code;CCR=California Code of Regulations V <br /> # Code Section <br /> V=Violation;RV=Re eat Violation V <br /> 1 HSC 25284 Permit too erate <br /> 2 CCR 2637 Seconda 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 res2onsibility and CFO letter <br /> ® 5 CCR 2632 b Monitoring Pro ram Monitoring&Response Plan)is current and approved b the local agency.0 <br /> 6 CCR 2712 i) Monitorina 21an is onsite. <br /> 7 CCR 2712 b Maintenance&monitoring records ( 1 <br /> 8 CCR 2643 d Daily monitorinE of suction piping(pre-January, 1, 1984) <br /> 9 HSC 25292.1 UST system isoperated to prevent unauthorized release <br /> 10 1 CCR 2632(c)(2) UST monitoring system is 2resent (M1) <br /> I 1 CCR 2630 d UST system monitoring equipment is 2ro2crIX located to detect a leak 1) <br /> 12 HSC 25291 b) nitoring a ui ment isoperational (M2) <br /> 13 CCR 2636 1 Continuous monitoring system for underground piping&UDC is present 1 <br /> 14 CCR 2631 a Primary containment is product ti ht <br /> 15 HSC 25291 a)(2Secondary containment for UST is tight <br /> 16 CCR 2636 c)(1) All releases in seconds 2iping flow to a collection sum <br /> 17 HSC 25291 t Line leak detectors are installed M1) <br /> 18 CCR 2635(b)(1) Spill container (M2) <br /> 19 CCR 2635(b)(2) Overfill 2revention system 2) <br /> 20 CCR 2636(a) Conventional suction piping shall have continuous monitorin &2°containment <br /> 21 HSC 25291 (e) Water in 2°containment analyzed&2ro2erly disposed of <br /> 22 CCR 2650 Recording/reporting of unauthorized releases (M 1) <br /> 23 CCR 2715 Designated Operator:(a)Statement from UST owner; (c-e)Monthly inspection:(t)Employee training <br /> 24 CCR 2638 a Annual monitoring certification <br /> 25 CCR 2638(a) Annual line leak detector test (M1) <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636 4) Annual line tightness test M1) <br /> 28 CCR 2661 (f) Repair for tank/2'2inE has had tightness test ( 2) <br /> 29 CCR 2643 e) Biennial tightness test of gravity pipingre-Janua 1, 1984) <br /> 30 CCR 2643 d) Triennial line test for conventional suction piping( re-Janua 1, 1984) (Ml) <br /> 31 HSC 25292.5 Double walls stem located within 1000'of public well-ELD <br /> 32 CCR 2661 Permit to repair UST s stem <br /> 33 1 HSC 25286 a Permit to alter monitoring system <br /> 34 HSC 25298 b) Permit to temporarily close UST system <br /> 35 HSC 25298 c) Permit to close UST system <br /> 36 HSC 25299 a)9) Disabling leak detection devices <br /> 37 HSC 25298 a) Illegal abandonment of UST system <br /> 38 Other: <br /> EHD INS P TOR: PHONE: UIC <br /> Septic system: <br /> -Serves>_20 people/day <br /> RECEI D BY: ^^ TITLE: –Receives other than sanitary waste <br /> L,t <br /> -Site— <br /> ./e- ^„ Other disposal methods: <br /> �/' 'f'` /- wells/French Brains <br /> EHD 23-02-002 REV 05/07 <br />