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SAN JOAQUIN COUNTY <br />*NVIRONMENTAL HEALTH DEPARTMENT* <br />304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br />Facility name: <br />Designated Operator: <br />Inspection Date: <br />\0�ID5 <br />Facility address: <br />UST # <br />Product <br />� !3\ <br />a <br />Facility Contact. Title: Phone: <br />`M nitoring Panel: <br />V Q-- <1 _3� <br />Pipp�ing system: <br />Ri'essurized ❑ Suction ❑ Gravity <br />Overfill prevention: <br />❑ Mechanical ❑ Audible/visual <br />Insrection type, <br />outine Monitoring Certification 11 Installation El Other: <br />Violations: <br />11Ml-RDetect 11M2-RPrev <br />� <br />S43 Both <br /># Code Section <br />VIOLATIONS) HSC=California Health & Safety Code; CCR=California Code of Regulations <br />V=Violation; RV=Re eat Violation <br />V R <br />V <br />1 HSC 25284 <br />Permit tooperate <br />2 CCR 2637 <br />Secondary containment test performed <br />3 CCR 2711 b & c <br />Current Unified Program Consolidated Forms on file with EHD(Facility and tank form) <br />4" " HSC 25292.2 <br />Certification of financial responsibility and CFO letter <br />5 CCR 2632 (c)(2 D) <br />Monitoring & response plan is current and filed with the local agency <br />6 CCR 2712 (i) <br />Monitoring & response plan is onsite <br />7 CCR 2712 b) <br />Maintenance & monitoring records <br />M1 <br />8 CCR 2643 (d) <br />Daily monitoring of suction piping (re -January, 1, 1984) <br />9 HSC 25292.1 <br />UST system isoperated to prevent unauthorized release <br />10 CCR 2632'(c)(Z) <br />UST monitoring system is present <br />Ml <br />11 CCR 2630 (d) <br />UST system monitoring equipment is properly located to detect a leak <br />Ml <br />12 HSC 25291 <br />UST system monitoring equipment isoperational <br />M2 <br />13 CCR 2636 1 <br />Continuous monitoring system for underground piping & UDC is present <br />M1 <br />14 CCR 2631 a <br />Primary containment is product tight <br />15 HSC 25291 a (2) <br />Secondary containment for UST is tight <br />16 CCR 2636 (c)(1) <br />All releases in secondary pipingflow to a collection sum <br />17 HSC 25291 <br />Line leak detector(s) are installed <br />Ml <br />.18 CCR 2635 (b)(1) <br />Spill container <br />(M2) <br />19 CCR 2635 (b)(2) <br />Overfill prevention system <br />M2 <br />20 CCR 2636 (a) <br />Conventional suction piping shall have continuous monitoring & 2° containment <br />21 HSC 25291 (e) <br />Water in 2° containment analyzed & properly disposed of <br />22 CCR 2650 <br />Recording/reporting of unauthorized releases <br />(Mi) <br />23 CCR 2715 <br />Designated Operator: (a) Statement from UST owner; (c -e) Monthly inspection; (f) Em 1oyee training <br />24 CCR 2638 a <br />Annual monitoring certification <br />25 CCR 2638 (a) <br />Annual line leak detector test <br />(Ml) <br />26 HSC 25284.2 <br />Annuals ill containment testing <br />27 1 CCR 2636 4 <br />Annual line tightness test <br />(MI) <br />28 CCR 2661 ( <br />Repair for tank/piping has had tightness test <br />(M2 <br />29 CCR 2643 (e) <br />Biennial tightness test of gravity pipingre-Janus 1, 1984 <br />30 CCR 2643 `d <br />Triennial line test for conventional suction piping in (pre -January 1, 1984) <br />(Mi) <br />31 HSC 25292.5 <br />Double walls stem located within 1000' of public well-ELD <br />32 CCR 2661 <br />Permit to repair UST system <br />33 HSC 25286 a <br />Permit to alter monitoring system <br />34 HSC 25298 (b) <br />Permit totemporarily close UST system <br />35 HSC 25298 c <br />Permit to close UST system <br />-36 HSC 25299 (a)(9) <br />Disabling leak detection devices <br />37 HSC 25298 a) <br />Illegal abandonment of UST system <br />38 Other: <br />EHD INSPECTOR: <br />>� C��� <br />PHONE: <br />��� _c.�• <br />UIC <br />Septic system: <br />11 Serves >_20 people/day <br />❑ Receives other than sanitary waste <br />Other disposal methods: <br />C Dry wells/French Drains <br />RECEI Y: <br />TITLE: <br />C//?a <br />EHD 23-02-002 <br />