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SAN JOAUIN COUNTY <br />*VIRONMENTAL HEALTH DEPARTMENT " <br />600 East Main Street, Stockton, California 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sj oq v.or /g ehd <br />UNDERGROUND STORAGE TANK (USTI PROGRAM INSPECTION T <br />Facilityname: Designated Operator: Inspection <br />Date: <br />AeK I <br />Facility, address: <br />�? <br />( <br />UST # I � <br />'Product9 <br />. <br />Faciii4p.pontaqt, <br />Title: Phone: <br />TI <br />rIng P I: <br />Pi ing system: <br />ressurized ❑ Suction ❑ Gravity' <br />Overfill prevention: <br />echanical ❑ Audible/visual <br />Inspection type: <br />10)Routine UWonitorin <br />Code Section <br />Violations: <br />Certification ❑ Installation ❑ Other: ❑ M1-RDetect ❑ M2-RPrev ❑ M-3 Both <br />) HSC=California Health & Safety Code; CCR=California Code of Regulations V R <br />V <br />V=Violation; RV=Re eat Violation <br />1 <br />HSC 25284 <br />Permit tooperate <br />2 <br />CCR 2637 <br />Secondary containment test performed \-"ate--01! <br />3 <br />CCR 2711 b & c <br />Current Unified Program Consolidated Forms on file with EHD(Facility and tank form <br />HSC 25292.2 <br />Certification of financial responsibility and CFO letter <br />5 <br />CCR 2632 b <br />Monitoring Program Monitorin Res onse Plan is current and approved by the local <br />6 <br />CCR 2712 i <br />Monitoring Ian is onsite. <br />7 <br />CCR 2712 b <br />Maintenance monitoring records 1 <br />8 <br />CCR 2643 d <br />Daily monitoring of suction piping (pre -January, 1, 1984 <br />9 <br />HSC 25292.1 <br />UST system isoperated to prevent unauthorized release <br />10 <br />CCR 2632 (c)(2) <br />UST monitoring system is present M1 <br />11 <br />CCR 2630 d <br />UST system monitoring equipment is properly located to detect a leak M1 <br />12 <br />HSC 25291 b <br />UST system monitoring equipment isoperational (M1 <br />13 <br />CCR 2636 1 <br />Continuous monitoring system for under roundi in & UDC is present M1 <br />14 <br />CCR 2631 a <br />Primary containment is product tight <br />15 <br />HSC 25291 a 2 <br />Secondarycontainment for UST is tight <br />16 <br />CCR 2636 (2 )(1) <br />All releases in seconda i in flow to a collection sum <br />17 <br />HSC 25291 <br />Line leak detectors are installed M1 <br />18 <br />CCR 2635 b 1 <br />Spill container 2 <br />19 <br />CCR 2635 (b)(2) <br />Overfill prevention system M2 <br />20 <br />CCR 2636 (a) <br />Conventional suction pipin shall have continuous monitoring & 20 containment <br />21 <br />HSC 25291 (e) <br />Water in 20 containment analyzed & properly disposed of <br />CCR 2650 <br />Recordin2/reporting of unauthorized releases M1 <br />23 <br />CCR 2715 <br />Designated Operator: Statement from UST owner; c- Monthly inspection; Employee training <br />24 <br />, <br />t CCR 2638 a <br />Annual monitorinq certification <br />25 <br />CCR 2638 a <br />Annual line leak detector test - 1 <br />122 <br />26 <br />HSC 25284.2 <br />Annuals ill containment testin -t - <br />27 <br />CCR 2636 4 <br />Annual line tightness test a (M1 <br />28 <br />CCR 2661 <br />Repair for tank/piping has had tightness test (M2) <br />29 <br />CCR 2643 a <br />Biennial ti htness test of gravity piping(pre-January 1, 1984 <br />30 <br />CCR 2643 d <br />Triennial line test for conventional suction pipin2 (pre-January1, 1984 1 <br />31 <br />HSC 25292.5 <br />Double walls stem located within 1000' of public well-ELD <br />32 <br />CCR 2661 <br />Permit to repair UST system <br />33 <br />HSC 25286 a <br />Permit to alter monitoring system <br />34 <br />137 <br />HSC 25298 b <br />Permit to temporarily close UST system <br />35 <br />HSC 25298 c <br />Permit to close UST s stem <br />36 <br />HSC 25299 <br />a 9 2 <br />Disabling leak detection devices <br />HSC 25298 (a) <br />Illegal abandonment of UST system <br />EHD INSPE PHONE: UiG <br />,- Septic system: <br />❑ Serves >_20 people/day <br />RECEIVED BY:I I TITLE:. ❑ Receives other than sanitary waste <br />QQQ Other disposal methods: <br />❑ Dry wells/French Drains <br />EHD 23-02-002 REV 8/08 <br />