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SAN JOAQUIN COUNTY <br />OVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, California 95202-3029 <br />Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: www.sjgov.orWe <br /># <br />UNDERGROUND STORAGE TANK (USTI <br />PROGRAM INSPECTION <br />REPORY <br />Facility name: <br />Permit to 22erate <br />2 <br />CCR 2637 <br />Designated Operator: Inspection Date: <br />D5,5 <br />3 <br />CCR 2711 (b) & (c) <br />Current Unified Pro gram.Consolidated Forms on file with EHD (Facility and tank form) <br />4 <br />6,1 <br />Facility addressi <br />5 <br />CCR 2632 (b) <br />Monitorina±Loam Monitorin &Res ones Plan is Land approved by the local agency. <br />UST # <br />CCR 2712 (i) <br />Monitorin lan is onsite. <br />7-1 <br />CCR 2712 (b) <br />Maintenance & monitoring records <br />Le 5 <br />< <br />CCR 2643 (d) <br />Daily monitorin of suction j2iping (pre -January, 1, 1984) <br />'Product noxe <br />FacilityContact: <br />Title: <br />Phone: <br />CCR 2632 (c)(2) <br />UST monitoring system is present <br />(Mi) <br />I I <br />CCR 2630 (d) <br />UST system monitorin- _uipment is properly located to detect a leak <br />(Mi) <br />12 <br />nitoring Panel: <br />Piping system: <br />(M2) <br />13 <br />CCR 2636(Mi) <br />Overfill prevention: <br />Ix, !?&C't <br />14 <br />It Pressurized <br />XSuction <br />0 Gravi!y <br />15 <br />Mechanical D Audible/visual <br />Inspection type: <br />-- <br />16 <br />CCR 2636 (c)(1) <br />All releases in second Tj iping flow to a collection sHM2 <br />violations: <br />tRoutine <br />TA Monitoring Certification <br />El Installation <br />El Other: <br />18 <br />[I M I -RDetect D M2-RPrev D M-3 Both <br /># <br />Code Section <br />VIOLATION(S) HSC=Califomia Health & Safety Code; CCR=Califomia Code of Regulations V KI <br />V=Violation; RV=Repeat Violation V <br />I <br />HSC 25284 <br />Permit to 22erate <br />2 <br />CCR 2637 <br />Secondary containment test performed <br />3 <br />CCR 2711 (b) & (c) <br />Current Unified Pro gram.Consolidated Forms on file with EHD (Facility and tank form) <br />4 <br />HSC 25292.2 <br />Certification of financial resRonsibility and CFO letter <br />5 <br />CCR 2632 (b) <br />Monitorina±Loam Monitorin &Res ones Plan is Land approved by the local agency. <br />6 <br />CCR 2712 (i) <br />Monitorin lan is onsite. <br />7-1 <br />CCR 2712 (b) <br />Maintenance & monitoring records <br />CCR 2643 (d) <br />Daily monitorin of suction j2iping (pre -January, 1, 1984) <br />HSC 25292.1 <br />UST system isoperated to prevent unauthorized release <br />10 <br />F8 <br />CCR 2632 (c)(2) <br />UST monitoring system is present <br />(Mi) <br />I I <br />CCR 2630 (d) <br />UST system monitorin- _uipment is properly located to detect a leak <br />(Mi) <br />12 <br />HSC 25291 (b) <br />UST system monitoring e ui ment is <br />(M2) <br />13 <br />CCR 2636(Mi) <br />Continuous monitorin&s����ng & UDC is 2resent <br />14 <br />CCR 2631 (a) <br />Prim containment is roduct ti ht <br />15 <br />HSC 25291 a) 2 <br />Secondary containment for UST is tight <br />16 <br />CCR 2636 (c)(1) <br />All releases in second Tj iping flow to a collection sHM2 <br />I <br />17 <br />HSC 25291 (f) <br />Line leak detector s) are installed <br />(MI) <br />18 <br />CCR 2635 (b)(1) <br />Spill container <br />(W) <br />19 <br />_ <br />CCR 2635 b 2) <br />Overfill prevention system <br />(M2) <br />20 <br />CCR 2636 (a) <br />Conventcontainment <br />21 <br />HSC 25291 (e) <br />Water in 2' containment analyzed & properly disposed of <br />22 <br />CCR 2650 <br />Recordingr2orting of unauthorized releases <br />23 <br />CCR 2715 <br />Designated !2perator: (a) Statement from UST owner; (c -e) Monthly inspection; <br />(f) Employee training <br />24 <br />CCR 2638 (a) <br />Annual monitoring certification <br />25 <br />CCR 2638 (a) <br />Annual line leak detector test <br />(Mi) <br />26 <br />HSC 25284.2 <br />Annual spill containment testing <br />27 <br />CCR 2636 (f)(4) <br />Annual line tightness test <br />(MI) <br />28 <br />CCR 2661 (f) <br />Repair for tank/, i, in. has had tightness test <br />(M2) <br />29 <br />CCR 2643 (e) <br />Biennial tightness test ofgzrja�viti 31 n (pre -January 1, 1984) <br />30 <br />CCR 2643 (d) <br />Triennial line test for conventional suction piRing (pre -January 1, 1984) <br />(Mi) <br />31 <br />HSC 25292.5 <br />Double wall system located within 1000' o <br />32 <br />CCR 2661 <br />Permit to repair UST system <br />33 <br />FISC 25286 (a) <br />Permit to alter monitorin system <br />34 <br />HSC 25298 (b) <br />Permit to L41mporarily close UST system <br />35 <br />1 HSC 25298 (c) <br />Permit to close UST system <br />36 <br />HSC 25299 (a)(9) <br />I Disabling leak detection devices <br />37 <br />HSC 25298 (a) <br />Illegal abandonment of UST system <br />38 <br />Other: <br />EHD INSPECTOR: <br />RECEIVED�-! <br />PHONE: <br />2 <br />TITLE: <br />A) AJ <br />UIC <br />otic system: <br />-,,Serves �!20 people/day <br />Receives other than sanitary waste <br />Other diMsal methods: <br />71 Dry wells/French Drains <br />EHD 23-02-002 REV 05/07 <br />