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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)468-3433 Web:www.sigov.org/�ehd <br /> UNDERGROUND TAN UST) PROGRAM INSPECTION <br /> Facility name: Designated Operator: I Inspection Date: <br /> F ill address: FITS-T#--, 77 , <br /> i <br /> Product <br /> Contact: Title: PhM) an <br /> tff-4 VO , <br /> nitoring Panel: LL�� <br /> ing system: Overfill prevention: <br /> -%(�l jg ressurized uction ❑Gravi!y k2echanical ❑Audible/visual <br /> [n pection type: Violations: <br /> Routine '�(Monitoring Certification ❑Installation ❑Other: M1-RDetect ❑M2-RPrev ❑M-3 Both <br /> # Code Section <br /> VIOLATION(S) HSC=Califomia Health&Safety Code;C R=Califomia Code of Regulations V V=Violation;RV=R eat Violation V <br /> I HSC 25284 Permit too erate <br /> 2 CCR 2637 Seconda containment test 2erformed <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 res2onsibility and CFO letter <br /> 5 CCR 2632 b Monitoring Pro ram Monitorin &Res once Plan)is current and approved by the local agency. <br /> 6 CCR 2712 i) Monitoring tan is onsite. <br /> 7 CCR 2712 b Maintenance&monitoring records 1) <br /> 8 CCR 2643 d Daily monitoring of suction i in re-Janus , 1, 1984) <br /> 9 1 HSC 25292.1 UST system isoperated to prevent unauthorized release <br /> 10 CCR 2632 c)(2) UST monitorin system is 2resent (MI) <br /> . 11 CCR 2630 d UST system monitoring equipment is properly located to detect a leak M1) <br /> 12 HSC 25291 b) UST system monitoring equipment iso erational (N12) <br /> 13 CCR 2636 I Continuous monitoring system for under round piping&UDC is 2resent (M1) <br /> 14 CCR 2631 a) Primary containment is product tight <br /> 15 HSC 25291 (a)(2Secon laa containment for UST is ti ht <br /> 16 CCR 2636(c)(1) All releases in secondary pipingflow to a collection sum <br /> 17 HSC 25291 Line leak detectors are installed M1) <br /> 18 CCR 2635 b) I) Spill container (M2) <br /> 19 CCR 2635 b 2 Overfill 2revention system (M2) <br /> 20 CCR 2636(a) Conventional suction pi2ing shall have continuous monitoring&2°containment <br /> 21 HSC 25291 (e) Water in 2°containment analyzed&pro erly dis osed of <br /> 22 CCR 2650 Recordin /re ortin of unauthorized releases (M 1 <br /> 23 CCR 2715 Desi nated Operator:(a)Statement from UST owner; (c-e)Monthly ins ection; t)Em to ee trainin <br /> 24 CCR 2638 a Annual monitorinE certification <br /> 25 CCR 2638 a) Annual line leak detector test (M 1) <br /> 26 HSC 25284.2 Annual s ill containment testing <br /> 27 CCR 2636(f)(4) Annual line tightness test MI) <br /> 28 CCR 2661 f) Repair for tank/piping has had tightness test (M2) <br /> 29 CCR 2643 e Biennial tightness test ofravit i in re-Janua 1, 1984) <br /> 30 CCR 2643 d) Triennial line test for conventional suction 2iping(pre-Janum 1, 1984 (M1) <br /> 31 1 HSC 25292.5 Double walls stem located within 1000'of public 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 tern2orarily close UST system <br /> 35 HSC 25298 c Permit to close UST system <br /> 36 HSC 25299(a)(9) Disablin leak detection devices <br /> 37 1 HSC 25298 a) illegal abandonment of UST system <br /> 38 1 Other: <br /> D tN E R: PONE- UIC <br /> Septic system: <br /> -Serves>20 people/day <br /> CEM T LE: a� -Receives other than sanitary waste <br /> Other disposal methods: <br /> LL7)o,tr -Dry wells/French Drains <br /> EHD 23-02-002 REV 05/07 <br />