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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.s*gov.org/ehd <br /> UNDERGROUND STORAGE TANK UST PROGRAM INSPECTION REPORT <br /> Facility n e: Designated Operator: Inspection <br /> Date <br /> Facility ad yeas UST# Z <br /> ✓{'� it/ /'/L� <br /> "Product <br /> Fac li Clo�ta t: itle•` one: <br /> WV' W,t5— <br /> Nj nitoring Pane Pi ing system: Overfill prevention: <br /> VIE f LZI jPressurized ❑Suction ❑Gravity Mechanical ❑Audible/visual <br /> Inspection type: )Violations: <br /> N/Poutine Monitoring Certification ❑Installation ❑Other: 1-RDetect ❑M2-RPrev ❑M-3 Both <br /> VIOLATION(S) HSC=California Health&Safety Code; C =California Code of Regulations V R <br /> # Code Section V <br /> V=Violation; RV=Re eat Violation <br /> 1 HSC 25284 Permit tooperate <br /> 2 CCR 2637 Secondary containment test performed <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 res o sibility and CFO letter <br /> 5 CCR 2632 b Monitoring Program (Monitoring& Response Plan is current and approved by the local agency. <br /> 6 CCR 2712 i Monitoring Ian is onsite. <br /> 7 CCR 2712 b Maintenance&monitoring records M1 <br /> 8 CCR 2643 d Daily monitoring of suction piping (pre-January, 1, 1984 <br /> 9 HSC 25292.1 UST system isoperated to prevent unauthorized release <br /> 10 CCR 2632(c)(2) UST monitoring system is present M1 <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 isoperational M1) <br /> 13 CCR 2636 1 Continuous monitoring system for underground piping& UDC is present M1 <br /> 14 CCR 2631 a Primary containment is product tight <br /> 15 1 HSC 25291 (a)(2) Secondary containment for UST is tight <br /> 16 CCR 2636(c)(1) All releases in secondary pipingflow to a collection sum <br /> 17 HSC 25291 Line leak detector(s) are installed M1 <br /> 18 CCR 2635(b)(1) Spill container M2) <br /> 19 CCR 2635 (b)(2) Overfill prevention system M2 <br /> 20 CCR 2636(a) Conventional suction piping shall have continuous monitoring&20 containment <br /> 21 HSC 25291 (e) Water in 20 containment analyzed& properly disposed of <br /> 22 CCR 2650 Record ing/repo rtin of unauthorized releases M1 <br /> 23 j CCR 2715 Designated Operator:M Operator: Statement from UST owner; -e Monthl inspection; m to ee training <br /> 24 CCR 2638 a Annual monitoring cert) (cation <br /> 25 CCR 2638 a Annual line leak detector test M1 <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636 4 Annual line tightness test M1) <br /> 28 CCR 2661 Repair for tank/piping has had tightness test (M2) <br /> 29 CCR 2643 a Biennial tightness test of gravity pipingre-Janus 1, 1984 <br /> IROCEIVED <br /> CCR 2643 d Triennial line test for conventional suction piping( re-Janus 1, 1984) (M1 <br /> HSC 25292.5 Double walls stem located within 1000'of public well-ELD <br /> CCR 2661 Permit to repair UST system <br /> HSC 25286 a Permit to alter monitoringsystem <br /> HSC 25298 b Permit to temporarily close UST system <br /> HSC 25298 c Permit to close UST system <br /> HSC 25299 Disabling leak detection devices <br /> a 9 2 <br /> HSC 25298 a illegal abandonment of UST system <br /> Other: _ <br /> SP CT PHON10 E ��� UIC <br /> Septic system: <br /> ❑Serves>_20 people/day <br /> BY TITL �� ii Receives other than sanitary waste <br /> Other disposal methods: <br /> P.Dry wells/French Drains <br /> EHD 23-02-002 REV 8/08 <br />