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it <br />• SAN JOAQUIN COUNTY DATE -� t2, Z J <br />P R# <br />ENVIRONMENTAL HEALTH DEPARTM T PAGE <br />304 E. Weber Ave., Third Floor, Stockton, CA 95202 <br />(209) 468-3420 <br />UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br />Facility Name t, � A,,, Facility Address /G(Z f _ 94 k l __ <br />Facilty Contact iii wArc L Lr 1 u Title „� Phone # <br />UST# Product fj UST# 2—Product <3 ( UST#_jProductc�..�UST# Product <br />Overfill Prevention: ❑ Audible/Visual "Mechanical Monitoring Panel: C - <br />Piping System: ❑ Gravity>CPressure ❑ Suction Violations: ❑ M1-RDet 0 M2-Rprev ❑ M3 -Both <br />Automatic Pump Shut Down Satisfies CCR 2636 (5): 4Yes ❑ No Designated Ooerator: <br />INSPECTION TYPE <br />COMPANY NAME: <br />�AQonitoring Certification- ❑Complaint ❑Install ❑Removal ❑Repair/Upgrade <br />TECHNICIAN NAME: <br />V IULH I IUNtO) <br />PHONE: <br />The above facility is not in compliance with the following section(s) of Health & Safety Code (HSC) and/or <br />California Code of Regulations (CCR): <br />1 <br />HSC 25284 <br />Permit to operate <br />23 <br />CCR 2643 (d) <br />Daily monitoring of suction <br />2 <br />CCR 2637 <br />Secondary cont. testing <br />piping (pre -1/1/84) <br />3 <br />CCR 2711(b) & (c) <br />Current State Forms A & B <br />24 <br />CCR 2636 (a) <br />Conventional suction piping <br />4 <br />HSC 25292.2 <br />Certification of financial <br />shall have continuous <br />responsibility & CFO letter <br />monitoring & 20 containment <br />5 <br />CCR 2632 (c)(2) <br />UST monitoring is present (M1) <br />25 <br />CCR 2643 (e) <br />Biennial tightness test of gravit, <br />6 <br />CCR 2630 (d) <br />UST system monitoring <br />piping (pre -1/1/84) <br />equipment is properly located to <br />26 <br />CCR 2643 (d) <br />Triennial line test for <br />detect a leak (M1) <br />conventional suction (pre - <br />7 <br />CCR 2637(b) <br />UST system monitoring <br />1/1/84) (M1) <br />equipment is operational (M1) <br />27 <br />CCR 2662 <br />1998 upgrade of UST system <br />8 <br />PICCR 2636 (f)(1) <br />Continuous monitoring system <br />28 <br />CCR 2661 <br />Permit to repair UST system <br />for underground piping & UDC <br />29 <br />HSC 25286 (a) <br />Permit to alter monitoring <br />is present (M1) <br />system <br />9 <br />CCR 2636 (c)(1) <br />All releases in secondary piping <br />30 <br />HSC 25298 (a) <br />Illegal abandonment of UST <br />flow to a collection sump <br />system <br />10 <br />HSC 25291 (f) <br />Line leak detector(s) (M1) <br />31 <br />HSC 25298 (b) <br />Permit to temporarily close US - <br />11 <br />HSC 25291(a)(2) <br />Secondary containment for <br />system <br />UST is tight <br />32 <br />HSC 25298 (c) <br />Permit to close UST system <br />12 <br />CCR 2635 (b)(1) <br />Spill container (M2) <br />33 <br />HSC 25292.1 <br />UST system is operated to <br />13 <br />HSC 25284.2 <br />Annual spill container testing <br />prevent unauthorized release <br />14 <br />CCR 2635 (b)(2) <br />Overfill prevention system (M2) <br />34 <br />CCR 2650 <br />Recording/reporting <br />15 <br />CCR 2631 (a) <br />Primary containment is product- <br />unauthorized release (M1) <br />tight <br />35 <br />HSC 25291 (e) <br />Water in 20 cont analyzed and <br />16 <br />CCR 2632 (d) <br />Monitoring & response plan <br />properly disposed of <br />17 <br />CCR 2712 (i) <br />Monitoring & response plan is <br />36 <br />CCR 2640 (e) <br />Single wall component within <br />on site <br />1 000'of Public Well, no ELD <br />18 <br />CCR 2712 (b) <br />Maintenance & monitoring <br />37 <br />CCR 2635(a)(2)(A) Cathodic protection testing & <br />records (M1) <br />60 day inspection log (M2) <br />19 <br />CCR 2636 (f)(4) <br />Annual line tightness test <br />38 <br />H&SC 25299(a)(9) <br />Disabling leak detect. Devices <br />20 <br />CCR 2630 (d) <br />Annual line leak detector test <br />39 <br />CCR 2715(a) <br />Statement from UST owner <br />(M1) <br />40 <br />CCR 2715(c) <br />Monthly inspection by D.O, <br />21 <br />CCR 2630 (d) <br />Annual monitoring certification <br />41 <br />CCR 2715 (f) <br />D.O. trained employees <br />22 <br />CCR 2661 (f) <br />Repair for tank/piping has had <br />42 <br />Violation(s) not listed above <br />tightness test (M2) <br />EHD INSPECTOR: <br />` <br />PHONEZOO( g — <br />RECEIVED BY: <br />Ll TITLE: <br />L/ b—F t n j — � vn. L,,. <br />UNITIII/UST/INSP (rev 7/21/04) <br />