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SAN JOAQUIN COUNTY <br /> OVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, California 95202-3029 <br /> Telephone: (209)468-3420 Fax:(209)468-3433 Web:www.sigov.org/LEeLnhda <br /> UNDERGROUND STORAGE TANK (USTI PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection <br /> Date: <br /> E7AVK- i9F IJorma,4(\ Wt�176 Of-t lo V <br /> Facility address: UST <br /> lq(w L'0C*hvC-b C-4 Product <br /> Facility Contact: Title: Phone: <br /> Ve 6 Z 5-7 <br /> Monitoring Panel: P7,A*ng system: Overfill prevention: <br /> 5 -Z,7 go I Pressurized IV/Suction 0 Gravity 0 Mechanical audible/visual <br /> Ins ction type: Violations: <br /> otutine [W/onitorin Certification El Installation 0 Other: 0 M1-RDetect 0 M2-RPrev El M-3 Both <br /> VIOLATION(S) HSC=California Health&Safety Code; CCR=California Code of Regulations V R <br /> # Code Section V=Violation; RV=Repeat Violation V I <br /> I HSC 25284 Permit tooperate <br /> CCR 2637 Seconda!j containment ttq2erformed <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 res onsibility and CFO letter <br /> 5 CCR 2632(b) Monitorin Program(Monitoring&Response Plan)is current and approved by the local <br /> 6 CCR 2712 Q Monitoring 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 iso crated to prevent unauthorized release <br /> 10 CCR 2632(c)(2) LIST monitoring system is present (MI) <br /> 11 CCR 2630(d) UST system monitoring equipment is properly located to detect a leak M1% <br /> 12 HSC 25291 (b) (MI) <br /> 13 CCR 2636(f]i(l) is present (Mi) <br /> 14 CCR 2631 (a).. <br /> 15 HSC 25291 (a)(2) <br /> 16 CCR 2636(c)(1) ii Seconda i in flow to a collection sum1 1 <br /> 17 HSC 25291 (9 Line leak detector(s)are installed (MI) <br /> 18 CCR 2635(b)(1) Spill container (1142) <br /> 19 CCR 2635(b)(2) Overfill prevention system (M2) <br /> 20 CCR 2636(a) Conventional suction i in shall have continuous monitorin &2°containment <br /> 21 HSC 25291 (e) Water in 20 containment analyzed&property disposed of <br /> 22 CCR 2650 Recording/re 2ortinq of unauthorized releases (MI) <br /> 23 . CCR 2715 Designated Operator: (a)Statement from UST owner; (c-e)Monthly inspection; (f)l Em loyee training <br /> j-CCR 2638(a) Annual monitoring certification <br /> 2 25 CCR 2638(a) Annual line leak detector test (Mi) <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636(f)(4) Annual line ti2htness test (MI) <br /> 28 CCR 2661 (� Repair for tank/piping has had tightness test (IM2) <br /> 29 CCR 2643 (e) Biennial tightness test of gravity pipin (pre-January 1, 1984) L J <br /> [2 <br /> 2 <br /> 2 <br /> 30 CCR 2643(d) Triennial line test for conventional suction <br /> 31 HSC 25292.5 Double walls stem located within 1000' of public well-ELD <br /> 32 CCR 2661 Permit to repair LIST system <br /> 33 HSC 25286(a) Permit to alter monitoringstem <br /> 34 HSC 25298(b) Permit to temporarily close UST system <br /> 35 HSC 25298(c) Permit to close LIST system <br /> 36 HSC 25299 Disabling leak detection devices <br /> a(9)jTj(2) <br /> 737 HSC 25298(a) Illegal abandonment of UST system ... <br /> 4 1 Other: UIC <br /> EHD INSPECTOR: PHONE: <br /> ef-6 Septic system: <br /> W) ,a -t/11 0 Serves�!:20 people/day <br /> -1 Rec, <br /> TIT E:: I- elves other than sanitary waste <br /> RE is <br /> Other disposal methods: <br /> 4�t U Dry wells/French Drains <br /> EHD 23-02-002 REV 8/08 <br />