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0 <br />0 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sicehd.com <br />UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br />Facility <br />Name: <br />Facility <br />Address: <br />Inspection <br />Date: <br />Non -Pressurized Piping V R COS <br />401 CCR 2636(a)(3) <br />Suction piping not properly sloped or incorrectly located check valve (V705) ❑ ❑ ❑ <br />402 CCR 2643(d) <br />Daily monitoring of suction pipe (pre -Jan 1984) not performed (V726) ❑ ❑ ❑ <br />403 CCR 2643(d) <br />Triennial 0.1 gph line test for conventional suction piping not performed (pre -January 1984) (V664) ❑ ❑ ❑ <br />404 CCR 2643(e) <br />Biennial 0.1 gph test for gravity piping not performed (pre -January 1984) (V665) ❑ ❑ ❑ <br />Other Violations V R COS <br />2010 See below <br />Unlisted Administration/Documentation violation (V736) ❑ ❑ ❑ <br />2030 See below <br />Unlisted Operations/Maintenance violation (V743) ❑ ❑ ❑ <br />2060 See below <br />Unlisted Design/Construction violation (V745) ❑ ❑ ❑ <br />SUMMARY OF VIOLATIONS <br />(CLASS 1, CLASS II, or MINOR — Notice to Comply <br />ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RATE. <br />THI ACILIT)f IS SUBJECT TO REINSPECTION AT ANY TIME AT END'S CURRENT HOURLY RATE. <br />Received b si atur <br />Title�1�qjze— <br />Date:v <br />Recei d rinted ame): <br />Inspector: <br />Inspector phone: <br />EHD 23-01 REV 10/07/14 Page 3 Us l INSNtc I IUN KIzVU c I <br />