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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)468-3433Web:www.sjgov.or e d <br /> UNDERGROUND STORAGE T CTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> S AFO�7 <br /> Facility address: UST# - n <br /> lW. i Product <br /> Facility Contact: Title: Phone: / <br /> c; ` NON0 ViAeA <br /> onitoring Pane Piping system: Overfill prevention: <br /> ressurized ❑Suction ❑Gravity echanical ❑Audible/visual <br /> .Inspection type: —-- olations: <br /> Routine Monitoring Certification ❑Installation ❑Other: ❑ 1-RDetect ❑M2-RPrev ❑M-3 Both <br /> VIOLATION(S) HSC=California Health&Safety Code;CCR=California Code of Regulations V <br /> Code <br /> Sectio® V <br /> V=Violation;RV=Re eat Violation <br /> 1 HSC 25284 Permit too erste <br /> 2 CCR 2637 Seconds containment test erfotcd <br /> 3 CCR 2711 b & c Current Unified Pro am Consolidated Forms on fele with EHD Facili and tank form) <br /> 4 HSC 25292.2 Certification of financial res onsibilit and CFO letter <br /> 5 CCR 2632 b Monitorin Pro am Monitorin &Res once Plan)is current and a roved by the local agency. <br /> 6 CCR 2712 i) Monitori Dian is onsite. <br /> 7 CCR 2712 b) Maintenance&monitorin records M1) <br /> 8 CCR 2643 d) Dail monitorin of suction i in re-Janu I, 1984) <br /> 9 HSC 25292.1 UST s stem iso erated to revent unauthorized release <br /> 10 CCR 2632 c)(2) UST monitorin s stem is resent ( l) <br /> I I CCR 2630(d) UST system monitoring a ui ment is pMerly located to detect a leak Ml <br /> 12 HSC 25291 b) UST system monitorini ui ment is,,operational (M2) <br /> 13 CCR 2636(f)(9 Continuous monitorin s stem for under ound i in &UDC is resent (Ml) <br /> 14 CCR 2631 (a) Prima containment is roduct ti ht <br /> 15 HSC 25291a) 2 Secondary containment for UST is tight <br /> 16 CCR 2636(c)(1) All releases in seconds i in flow to a collection sum <br /> 17 HSC 25291 (f) Line leak detector s)are installed (Ml) <br /> 18 CCR 2635(b) 1) S ilfl container (M2) <br /> 19 CCR 2635 b)(2) Overfill revention s stem (M2) <br /> 20 CCR 2636(a) Conventional suctioni in shall have continuous monitoring&2°containment <br /> 21 HSC 25291 (e) Water in 2°containment analyzed&properly disposed of <br /> 22 CCR 2650 Recordin rortin of unauthorized releases I) <br /> 23 CCR 2715 Desi nated O crator:(a)Statement from UST owner, (c-e) onthl ins ection,(f)Em to ee training <br /> 24 CCR 2638 a Annual monitorin certification <br /> 25 CCR 2638(a) Annual line leak detector test (MI) <br /> 26 HSC 25284.2 Annual s ill containment testin <br /> 27 CCR 2636(f)(4) Annual line ti htness test (MI) <br /> 28 CCR 2661 (f) REpair for tank/ i in has had ti htness test (M2) <br /> 29 1 CCR 2643 e) 13iennial ti htness test of avit i in re-Janus 1, 1984) <br /> 30 CCR 2643 d) Triennial line test for conventional suction piping(pre-JanuaryI, 1984) ( i) <br /> 31 HSC 25292.5 Double walls stem located within 1000'of ublic well-ELD <br /> 32 CCR 2661 Permit to r air UST s stem <br /> 33 HSC 25286 a) Permit to alter monitoring system <br /> 34 HSC 25298(b) Permit to tem oraril close UST system <br /> 35 1 HSC 25298 c) Permit to close UST system <br /> 36 HSC 25299(a) 9) Disablin leak detection devices <br /> 3 HSC 25298 a) Illi3,al abandonment of UST system <br /> 3 Other: <br /> INP 1 O PHONE: � UIC <br /> �S, �J l Septic system: <br /> ❑Serves>_20 people/day <br /> RECE ED TITTE 7 Receives other than sanitary waste <br /> Other disposal methods: <br /> Dry wells/French Drains <br /> EHD 23-02-002 REV 05/07 <br />