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SAN JOAQUIN COUNTY DATE <br />PR# <br />OVIRONMENTAL HEALTH DEPART&T PAGE <br />304 E. Weber Ave., Third Floor, Stockton, CA 95202 <br />(209) 468-3420 <br />UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br />Facility Name LLAIL., Facility Address eofigL Qtn% <br />Facility Contact u_ �Ip�Title Phone # <br />UST# _ Product UST# Product UST#_Product UST# Product <br />Overfill Prevention: ❑/ udibleNis�I Cl MecVsluction <br />ical Monitoring Panel: <br />Piping System: V Gravity N'Pressure Violations:inor ❑ Major <br />Automatic Pump Shut Down Satisfies CCR 2636 (g): El Yes Ao Dispenser Pan: VYes ❑ No <br />INSPECTION TYPE: ❑Routine ❑Monitoring Certification ❑Complaint ❑Install ❑Removal ❑Repair/Upgrade <br />COMPANY NAME: <br />NICIAN <br />VIOLATION(S) <br />PHONE: <br />The above facility is not in compliance with the following section(s) of Health & Safety Code (HSC) and/or <br />California Code of Regulations (CCR): <br />1 <br />HSC 25284 <br />Permit to operate <br />2 <br />CCR 2637 <br />Secondary cont testing (6 <br />21 <br />CCR 2636 (f)(4) <br />month/36 month) <br />3 <br />CCR 2711(b) & (c) Current State Forms A & B <br />4 <br />HSC 25292.2 <br />Certification of financial <br />Annual monitoring certification <br />24 <br />responsibility and letter from <br />Daily monitoring of suction <br />chief financial officer <br />5 <br />CCR 2630 (d) <br />Continuous monitoring system <br />monitored <br />25 <br />for UST system <br />6 <br />CCR 2636 (c)(1) <br />All releases in secondary piping <br />shall have continuous <br />flow to a collection sump <br />7 <br />HSC 25291 (e) <br />Water in secondary (20) cont <br />8 <br />HSC 25291 (f) <br />Automatic line leak detector(s) <br />9 <br />CCR 2636 (f)(1) <br />Continuous monitoring system <br />monitored <br />27 <br />for underground piping <br />10 <br />CCR 2632 (c)(2) <br />Continuous monitoring system <br />system <br />28 <br />for UST <br />11 <br />HSC 252911 a)(2) <br />Secondary containment for. <br />Perm, to.aNer monitoring <br />UST is tight <br />12 <br />CCR 2636 (f)(1) <br />Continuous monitoring system <br />IIIA abandonment of UST <br />_ <br />for dispenser system <br />13 <br />CCR 2635 (b)(1) <br />Spill container <br />14 <br />CCR 2635 (b)(2) <br />Overfill prevention system <br />15 <br />CCR 2631 (a) <br />Primary containment is product - <br />Permit to close UST system <br />33 <br />tight <br />16 <br />HSC 25292.1 <br />UST system is operated to <br />properly disposed of <br />34 <br />prevent unauthorized release <br />17 <br />CCR 2650 <br />Recording/reporting <br />1000' of Public Well, no ELD <br />35 <br />unauthorized release <br />18 <br />CCR 2632 (d) <br />Monitoring & response plan <br />19 <br />CCR 2712 (i) <br />Monitoring & response plan is <br />on site <br />UNITIIWSTANSP (rev 724/02) <br />20 <br />CCR 2712 (b) <br />Maintenance & monitoring <br />records <br />21 <br />CCR 2636 (f)(4) <br />Annual line tightness test <br />22 <br />CCR 2630 (d) <br />Annual line leak detector test <br />23 <br />CCR 2630 (d) <br />Annual monitoring certification <br />24 <br />CCR 2643 (d) <br />Daily monitoring of suction <br />piping that is not continuously <br />monitored <br />25 <br />CCR 2636 (a) <br />Conventional suction piping <br />shall have continuous <br />monitoring & 20 containment <br />26 <br />CCR 2643 (e) <br />Biennial tightness test of gravity <br />piping that is not continuously <br />monitored <br />27 <br />CCR 2662 <br />Upgrade requirements for UST <br />system <br />28 <br />CCR 2661 <br />Permit: to repa.i; UST system <br />29 <br />HSC 25286 (a) <br />Perm, to.aNer monitoring <br />sys o.". <br />30 <br />HSC 25298 (a) <br />IIIA abandonment of UST <br />system - <br />31 <br />HSC 25298 (b) <br />Permit to temporarily close UST <br />sy9tem <br />32 <br />HSC 25298 (c) <br />Permit to close UST system <br />33 <br />HSC 25291 (e) <br />Water in 20 cont analyzed and <br />properly disposed of <br />34 <br />CCR 2640 (e) <br />Single wall component within <br />1000' of Public Well, no ELD <br />35 <br />CCR 2635(a)(2)(A) Cathodic protection testing <br />36 <br />H&SC 25299(a)(9) Disabling leak detect. devices <br />37 <br />Violation(s) not listed above <br />