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SAN JAUIN COUNTY <br /> NVIRONENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,California 95202-3029 <br /> Telephone:(209)468-3420 Fax. (209)468-3433 Web:www.sigov.or /�ehd <br /> STP INSPECTION T <br /> Facility name: Designated Operator: Inspection Date: <br /> Geov e <br /> Facifily a dr ss: UST# <br /> Oil KA tA 'Product �-Iidse <br /> �Facilit3Contact: Title: Phone: <br /> PmAvllt <br /> Panel: Piping system: ' Overfill prevention: <br /> 7nitoring <br /> fZ/ - 'A ❑Pressurized Suction ❑Gravity Mechanical Audible/visual <br /> Inspection type: Violations: <br /> Routine Monitoring Certification ❑Installation ❑Other: ❑MI-RDetect ❑M2-RPrev ❑M-3 Both <br /> VIOLATION(S) HSC=California Health&Safety Code;CCR=Califomia Code of Regulations V R <br /> Code Section V <br /> V=Violation;RV= eat Violation <br /> 1 HSC 25284 Permit tooperate <br /> 2 CCR 2637 Second containment test erformed <br /> 3 CCR 2711 b & c Current Unified Program Consolidated Forms on file with EHD ffaciliand tank form <br /> 4 HSC 25292.2 Certification of financial responsibility and CFO letter <br /> 5 CCR 2632 b Monitoring Program(Monitoring&Response Plan is current and approved by the local agency. <br /> 6 CCR 2712 i) Monitoring plan is onsite. <br /> 7 CCR 2712 b) Maintenance&monitorin records Ml) <br /> 8 CCR 2643 d) Daily monitoring of suction pi2ing(RMJanuary, 1, 1984) <br /> 9 HSC 25292.1 UST system isoperated to 2revent unauthorized release <br /> 10 CCR 2632 c)(2) UST monitorin system is present (Ml) <br /> 1 l CCR 2630 d) UST system monitoring equipment is properly located to detect a leak Ml <br /> 12 HSC 2529LDL UST s Lstem monitorin ui ment is stational (M2) <br /> 13 CCR 2636 1 Continuous monitoring s stem for underground piping&UDC is resent Ml <br /> 14 CCR 2631 a Primary containment is roduct tight <br /> 15 HSC 25291 (a)(2) Second2a containment for UST is tight <br /> 16 CCR 2636 c)d All releases in second2a Ripingflow to a collection sum <br /> L20 <br /> HSC 25291 Line leak detecto s)are installed (Ml) <br /> CCR 2635 b)(1) S ill container M2) <br /> CCR 2635 b)(2) Overfill revention s stem M2) <br /> CCR 2636(a) Conventional suction i in shall have continuous monitorin &2°containment <br /> HSC 25291 (e) Water in 2°containment analyzed&Eroperly disposed of <br /> 22 CCR 2650 Recording/reporting of unauthorized releases ( l <br /> 23 CCR 2715 DesignatedOperator: a)Statement from UST owner; (c-e)Monthly inspection;(f)Employee trainin <br /> 24 CCR 2638 a Annual monitoring certification <br /> 25 CCR 2638(a) Annual line leak detector test ( l) <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636 4) Annual line tightness test l) <br /> 28 CCR 2661 (f) Repair for tank/piping has had tightness test (M2) <br /> 29 CCR 2643 e Biennial ti htness test of gravity pipingre-January1, 1984 <br /> 30 CCR 2643 d) Triennial line test for conventional suction pi2ing( re-Janu 1, 1984) (Mi) <br /> 31 HSC 25292.5 Double walls stem located within 1000'of 2ILblic well-ELD <br /> 32 CCR 2661 Permit to repair UST system <br /> 33 HSC 25286 a Permit to alter monitoring system <br /> 34 HSC 25298(b) Permit to t=o 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 /> ETD INSP CTO : PHONE: UIC <br /> � S�,pe tic system: <br /> Serves>_20 people/day <br /> C ED BY: TITLE: 00, ❑Receives other than sanitary waste <br /> Other disposal methods: <br /> Dry wells/French Drains <br /> EHD 23-02-002 REV 05/07 <br />