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SAN JOAQUIN COUNTY <br /> qNV IRONMENTAL HEALTH DEPARTMENT 10 <br /> ` ' 304 East Weber Avenue,3`d Floor,Stockton,CA 95202-2708 <br /> t,l®C' Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.s.Igov.org/ehd <br /> �i UNDERGROUND STORAGE TANK(USTI PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> Facility addr^esss]: UST# <br /> Product �/ P <br /> Facili01 <br /> ty Contact: 9 Title Phone: <br /> Mo it r'ng Panel: Pipin stem: Overfill prevention: <br /> Z!, ressurized ❑Suction Gravity ❑Mechanical ❑Audible/visual <br /> Insp tion type: k- rViolations: <br /> 4W <br /> outine onitorin Certification ❑Installation ❑Other: MI-RDetect ❑M2-RPrev ❑M-3 Both <br /> # Code Section VIOLATION(S) HSC=Califomia Health&Safety Code;CCR=California Code of Regulations V R S <br /> V=Violation;RV=Re eat Violation V <br /> 1 HSC 25284 Permit too erate <br /> 2 CCR 2637 Secondary containment test performed <br /> CCR 2711 b & c Current Unified Pro am Consolidated Forms on file with EHD F cility and tank form <br /> 4 HSC 25292.2 CALCertification of financial responsibility and CFO letter <br /> 5 CCR 2632 c Monitoring&response plan urren nd filed with the local a enc <br /> 6 CCR 2712 i) Monitoring&response Elan is onse e <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 s stem is present Ml <br /> I 1 CCR 2630 d UST system monitoring equipment is properly located to detect a leak Mi <br /> 12 HSC 25291 UST system monitoring equipment is o rational M2 <br /> 13 CCR 2636 1 Continuous monitoring system for underground piping&UDC is lyesent M- <br /> 14 CCR 2631 a PriqM containment is product tight <br /> 15 HSC 25291 (a)(2) Secondary containment for UST is ti ht <br /> 16 CCR 2636(c)(1) All rele piping flow o a collection sump <br /> T'HSC 25291 Line leak detectors are installe 1 '"r Ml <br /> CCR2635(b)(1) Spill container M2 <br /> 19 CCR 2635(b)(2) Overfill prevention system M2 <br /> 2,0 1 CCR 2636(a) Conventional suction piping shall have continuous monitorin' &2°containment <br /> 1 HSC 25291 (e) Water in 2°containment analyzed&properly dis osed of gkA im 97 9V <br /> 2 CCR 2650 Recordin'' re orcin of unauthorized releases MI <br /> 23 CCR 2715 DesignatedOperator: a Statement from UST owner; (c-eMonthly inspection; Em to ee trainin <br /> 24 CCR 2638 a Annual monitoring certification <br /> CCR 2638 a Annual line leak detector test Ml <br /> 26 1 HSC 25284.2 Annual spill conta nmettt testing <br /> 27 CCR 2636 4 Annual line tightness test Ml <br /> 28 CCR 2661 Repair for tank/ i in has had tightness test (M2 <br /> 29 CCR 2643 e Biennial tightness test of gravity )ipingre-Janus 1, 1984 <br /> 30 CCR 2643(d) Triennial line test for conventional suction piping(pre-January1,1984 Ml <br /> 31 HSC 25292.5 Double walls stem located within 1000'of 2ublic well-ELD <br /> 32 CCR 2661 Permit to"repair UST system <br /> 33 HSC 25286 a Permit to alter monitorinE system <br /> 34 HSC 2529$ Permit to temporarily close UST system <br /> 35 HSC 25298 c Permit to close UST system <br /> 36 HSC 25299(a)(9) Disabling' leak detection devices <br /> 37 1 HSC 25298 a) illegal abandonment of UST system <br /> 38 1 Other: <br /> EHD INSPECTOR PRONE: UIC <br /> Se tic system: <br /> Serves>_20op ay <br /> RECE D TI Receiv sot r t itary waste <br /> Other isno e od <br /> t E ells renc ains <br /> EHD 23-02-002 <br />