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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.sigov.org/ <br />UNnF.RG Rn11TND fiTORAGF, TANK (UST) PROGRAM INSPECTION REPORT <br />Facility name: <br />Code Section <br />Designated Operator: <br />Inspection Date: <br />HSC 25284 <br />Permit tooperate <br />C�nlrl� <br />SIS o <br />ft <br />Secondary containment test performed <br />3 <br />Facilitaddress: <br />Current Unified Program Consolidated Forms on file with EHD Facili and tank form <br />UST # <br />HSC 25292.2 <br />, <br />Lvq^ <br />/ <br />Product <br />6 <br />1 CCR 2712 i) <br />Monitoring plan is onsite. <br />Facility Contact: <br />Title: Phone: <br />CCR 2712 ) <br />Maintenance & monitoring records <br />Ml <br />8 <br />CCR 2643 d) <br />Daily monitoring of suction piping (pre -January, 1, 1984) <br />9 <br />HSC 25292.1 <br />UST system isoperated to prevent unauthorized release <br />t ring Pane <br />10 <br />Piping system: <br />Overfill prevention: <br />y1V�on <br />11 <br />Pressurized ❑ Suction ❑ Gravity <br />Mechanical ❑ Audible/visual <br />Inspection type: <br />12 <br />Violations: <br />*Routine <br />Monitoring Certification ❑ Installation ❑ Other: <br />M-RDetect ❑ M2-RPrev ❑ M-3 Both <br /># <br />Code Section <br />VIOLATION(S) HSC=California Health & Safety Code; CCR=California Code of Regulations V R <br />V=Violation; RV=R eat Violation V <br />1 <br />HSC 25284 <br />Permit tooperate <br />2 <br />CCR 2637 <br />Secondary containment test performed <br />3 <br />CCR 2711 b) & c) <br />Current Unified Program Consolidated Forms on file with EHD Facili and tank form <br />4 <br />HSC 25292.2 <br />Certification of financial responsibility and CFO letter <br />5 <br />CCR 2632 b <br />Monitoring Program(Monitoring & Response Plan is current and approved by the local agency. <br />6 <br />1 CCR 2712 i) <br />Monitoring plan is onsite. <br />7 <br />CCR 2712 ) <br />Maintenance & monitoring records <br />Ml <br />8 <br />CCR 2643 d) <br />Daily monitoring of suction piping (pre -January, 1, 1984) <br />9 <br />HSC 25292.1 <br />UST system isoperated to prevent unauthorized release <br />10 <br />CCR 2632 (c)(2) <br />UST monitoring system is pLesent <br />I) <br />11 <br />CCR 2630 d <br />UST system monitoring equipment is properly located to detect a leak <br />Ml <br />12 <br />HSC 25291 ) <br />UST system monitorin equipment is operational <br />012 <br />13 <br />CCR 2636 1) <br />Continuous monitoring system for under ound ipinE & UDC is present <br />(l <br />14 <br />CCR 2631 (a) <br />Primary containment is product fight <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 secondary piping flow to a collection sum <br />17 <br />HSC 25291 <br />Line leak detector(s) are installed <br />Mi) <br />18 <br />CCR 2635 (b)(1) <br />Spill container <br />(M2) <br />19 <br />CCR 2635 (b)(2) <br />Overfill prevention system <br />(M2) <br />20 <br />CCR 2636 (a) <br />Conventional suction piping shall have continuous monitoring & 2° containment <br />21 <br />HSC 25291 (e) <br />Water in 2° containment analyzed & properly disposed of <br />22 <br />CCR 2650 <br />Recording/reporting of unauthorized releases <br />(Ml) <br />23 <br />CCR 2715 <br />DesignatedOperator: (a) Statement from UST owner; (c- Monthl ins ection; f) m to ee training <br />24 <br />CCR 2638 a <br />Annual monitoring certification <br />25 <br />CCR 2638 (a) <br />Annual line leak detector test <br />(Ml) <br />26 <br />HSC 25284.2 <br />Annuals ill containment testing <br />27 <br />CCR 2636 4 <br />Annual line tightness test <br />(Mi) <br />28 <br />CCR 2661 (f) <br />Repair for tank/piping has had tightness test <br />(M2) <br />29 <br />CCR 2643 a <br />Biennial tightness test of gravity pipingre-Janus 1, 1984 <br />30 <br />CCR 2643 (d) <br />Triennial line test for conventional suction piping (re -Jams 1, 1984) <br />(MI) <br />31 <br />HSC 25292.5 <br />Double wall s stem located within 1000' of public well-ELD <br />32 <br />CCR 2661 <br />Permit to repair UST system <br />33 <br />HSC 25286 (a) <br />Permit to alter monitoring system <br />34 <br />HSC 25298 (b) <br />Permit to temporarily close UST system <br />35 <br />HSC 25298 c <br />Permit to close UST system <br />36 <br />HSC 25299 a)(9) <br />Disabling leak detection devices <br />37 <br />HSC 25298 a) <br />Illegal abandonment of UST system <br />38 <br />Other: <br />EHD INSPECTOR: <br />PHONE: <br />C k <br />V <br />UIC <br />otic system: <br />❑ Serves >_20 people/day <br />❑ Receives other than sanitary waste <br />Other disposal methods: <br />❑ Dry wells/French Drains <br />CEIV D <br />% ti • <br />TITLE: <br />/ ' r �it ✓i --- <br />EHD 23-02-002 REV 05/07 <br />