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0 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.sjgov.orgjehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> ftAU4 9-I-Xi 414, 6. 30.6 <br /> Facility address: UST# C) <br /> Product <br /> Facility Contact: Title: Phone: <br /> 0 1 <br /> Vitoring Panel: rlying system: Overfill prevention: <br /> P.1-t)(-, XPressurized El Suction El Gravity YMechanical El Audible/visual <br /> Inspection type: Violations: <br /> VRoutine El Monitoring Certification El Installation El Other: MI-RDetect 11 M2-RPrev 0 M-3 Both <br /> F I# Code Section VIOLATION(S) HSC=Califomia Health&Safety Code;CC =California Code of Regulations — V R <br /> V=Violation;RV=Repeat Violation V <br /> I HSC 25284 Permit too2erate <br /> 2 CCR 2637 -Seconds containment test 2erformed <br /> 3 CCR 2711 (b)&(c) Current Unified Program Consolidated Forms on file with EHD ffacility and tank form) <br /> 4 HSC 25292.2 Certification of financial res2onsibiliand CFO letter <br /> 5 CCR 2632(b) MonitorinProram Monitorin &ResRonse Plan)is current and a2proved by the local agency. <br /> 6 CCR 2712(i) Monitoring Elan is onsite. <br /> 7 CCR 2712(b) Maintenance&monitoring records (Mi) <br /> 8 CCR 2643 d) Daily monitoring of suction 1pijjin (Ere-January, 1, 1984) <br /> 9 HSC 25292.1 UST system isoperated to prevent unauthorized release <br /> 10 CCR 2632(c)(2) UST monitorinsystem is present (MI) <br /> 11 CCR 2630(d) UST system monitorino,ey-p—q—is-,---rly located to detect a leak jm 1) <br /> 12 HSC 25291 (b) UST system monitoring equi2ment isoperational (M2) <br /> 13 CCR 2636(n(lContinuous monitoring system for underground pipin &UDC is present 1) <br /> 14 CCR 2631 (a) Prima Ly containment is product tight <br /> 15 HSC 25291 (a 2) Secondary containment for UST is ti ht <br /> 16 1 CCR 2636 cI) All releases in seconds a piping flow to a collection sum2 <br /> 17 HSC 25291 (9 Line leak detectors)are installed <br /> 18 CCR 2635(b)(1) Spill container (M2) <br /> 19 CCR 2635(b)(2) Over-fill prevention system (M2) <br /> 20 CCR 2636(a) Conventional suction 2i2ing shall have continuous monitorin &2'containment <br /> 21 HSC 25291 (e) Water in 2'containment analyzed&pro2erly disposed of <br /> 22 CCR 2650 Recording/reporting of unauthorized releases <br /> 23 CCR 2715 Designated 02erator:(a)Statement from UST owner; (c-eMonthly inspection;(1)Em2loyee trainin� <br /> 24 CCR 2638 a) Annual monitoring certification <br /> 25 CCR 2638(a) Annual line leak detector test (M1) ve, <br /> 26 HSC 25284.2 Annual s2ill containment testin� <br /> 27 CCR 2636(f)(4) Annual line tij,,htness test (M1 <br /> 28 CCR 2661 (f) Repair for tank/2i2inhas had tightness test (M2) <br /> 29 CCR 2643(e) Biennial ti htness test of gravity pi2inre-Janus a 1, 1984) <br /> 30 1 CCR 2643(d) Triennial line test for conventional suction 2iping(pre-January 1, 1984) <br /> 31 HSC 25292.5 Double walls stem located within 1000'of Eublic well-ELD <br /> 32 CCR 2661 Permit to repair UST system <br /> 33 HSC 25286(aPermit to alter monitorinE system <br /> 34 HSC 25298(b) Permit to temgorarily close UST system <br /> 35 HSC 25298(c) Permit to close UST system <br /> 36 1 HSC 25299(a)(9) Disabling leak detection devices <br /> 37 HSC 25298(a) Illegal abandonment of UST system <br /> 38. Other: <br /> E <br /> Septic system: <br /> -Serves�!20 people/day <br /> RECEIXED BY: TITLE: -Receives other than sanitary waste <br /> Other disposal methods: <br /> I I -Dry wells/French nrains <br /> EHD 23-02-002 REV 05/07 <br />