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WISAN JOAQUIN COUNTY <br />RONMENTAL HEALT14 DEPARTMENT . <br />304 East Weber Avenue, 3�a Floor; Stockton, CA 95202-2708 <br />eFhoirre <br />—Al 4fi8=3A20 - <br />UNDERGROUND STORAGE TANK <br />z Facility name: jr ` <br />I os O I I <br />Facilit ddress: <br />'Lid-' <br />Facility Contact: Title: <br />ry` A'j�[ 0. v P 2 W'f A) Tr- <br />'l <br />Monitbrit�g Panel: Piong system: <br />f 0 R, 1') I EYPressurized ❑ Suction f <br />Inspection type: <br />d, Routine rym.itoting Certification ❑ Installation <br /># Code section ' VIOLATION(S), HSC=Californ <br />3T) PROGRAM INSPECTION REPORT <br />Designated Operator: Inspection Date: <br />UST # r. <br />Product <br />'7u - <br />Overfill prevention: <br />vi ❑Mechanical ❑ Audible/visual <br />Violations: <br />er: 11M1-RDetect ❑ M2-RPrev ❑ M-3 Both <br />!alth & Safety Code; CCR=California Code of Regulations V I R <br />_� ___r♦�-n ___ v._t...__� V <br />``2 CCR 2137' <br />0 <br />F.Hn 23-02-002 <br />Secondary c. test performed <br />3 <br />CCR 2711 & c <br />Current Unified Program Consolidated Forms on file with EHD(Facility and tank form <br />4 <br />HSC 25292.2 <br />Certification of financial responsibilityand CFO letter' <br />5 <br />CCR 2632 c 2 D <br />Monitoring & res onse plan is current and filed with the local agency <br />6 ' <br />CCR 2712;.0 <br />nmitnt im &, use lam s, atsaite <br />7 1 <br />CCR 2712 b) <br />Maintenance & monitoring records <br />Ml <br />,8 <br />CCR 2043(d) <br />Daily monitoring of suctionpiping ('re -Jams'' , 1, 1984) <br />9 <br />HSC 25292.1 <br />UST system is o erated to prevent unauthorized release <br />10 <br />CCk'2632' c (2 <br />UST monitoring s`tem'is resent <br />(MI) <br />11 <br />CCR 2630 (d) <br />UST system monitorina a ui ment is pLo2erly located to detect a leak <br />(M1 <br />12 <br />2T2-- b <br />UST system monitoring *ipWt iso erational <br />M2) <br />13 <br />CCR 2636 00)Continuous <br />monitoring s stem for underground piping & UDC is present <br />(Ml) <br />14 <br />CCR 2U31 a <br />containment is, roduct tight <br />15 <br />HSC 25291 (a)(2 <br />Second containment for UST is tight <br />16 <br />CCR 2636 c 1, <br />All releases in second i °in Aouv to a collection sump <br />17 1 <br />HSC 25291 <br />Line leak detectors are installed <br />(MI) <br />1 ],CCR <br />2635' . J <br />S container <br />(M2)- <br />19 <br />CCR 2635 2 <br />Overfill prevention system <br />M2 <br />Zfl <br />CCft 2636 (a) <br />Conventional suction pipipg:shall have coutinuous monitoring" & 20 containment <br />21 <br />HSC 25291 (e) <br />Water in 2° containment anal ed & ro erly disposed of <br />GR 265Q <br />Recoidirt r n = of unau mcij i releases <br />23 <br />CCR 2715 <br />Desi atedOperator: a Statement from UST owner; (c -e) Monthly inspection; (f) Employee tramin .� <br />24 <br />CCR 2638: a <br />Annual monitorin certiiicancan " <br />25 <br />CCR 2638(a) <br />Annual line leak detector test <br />(Ml) <br />26 <br />HSC 254:2 <br />Anniial ill ettntamnettt tetin <br />27 <br />CCR 2636 4 <br />Annual line tightness test <br />(Mi) <br />28, <br />CXjL 2661 <br />Repairfor tank) i '' lias.htiai ti tness test - <br />(M2) ' <br />29 <br />CCR 2643 a <br />Biennial tightness test of gravity gipinre-Janupa1, 1984 <br />30 <br />CCR 2643' <br />Triennial line test for conveztt' al suction i' iii -January1, 1984 <br />(MI <br />31 <br />HSC 25292.5 <br />Double wall astern located within 1000' of public well-ELD <br />32 <br />CCR 2661 <br />hm it to repair UST system <br />33 <br />HSC 25286 a <br />Permit to alter monitoring system <br />,134 <br />:HSC 25298 @) <br />ermit to lye] UST7ystem <br />35 <br />HSC 25298 (c) <br />Permit to close UST system <br />3fr ' <br />HSC 25299 (a)(9) <br />Oisabliri leak detection duces <br />37 <br />HSC 25298 a <br />Illegal abandonment of UST system <br />38 <br />`Other: <br />EHD INSPECTOR: <br />PHONE: <br />UIC <br />P ; <br />(� �. f U "� C1 <br />otic system: <br />❑ Serves >_20 people/day <br />RECEIVED BY: <br />TITLE: t <br />❑ Receives other than sanitary waste <br />t e -- • - _._ . - <br />Other disposal methods: <br />✓ pf <br />❑ Dry wells/French Drains <br />0 <br />F.Hn 23-02-002 <br />