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SAN JOAQUIN COUNTY <br />OENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, California 95202-3029 <br />Telephone: (209) 468-3420 Fax.- (209) 468-3433 Web: www.sjgov.orgLehd <br />UNDERGROUND STORAGE TANK tUSTJ PROGRAM INSPECTION REPORT <br />Facility name: Designated Operator: Inspection Date: <br />cit 1S o <br />Facifitaddress: UST # <br />'Product <br />Facilty Contact: Title: Phone: <br />Va4i mvq <br />onit ring Pane Piping system: Overfill prevention: <br />�/1112 eh5l— It Pressurized 0 Suction 0 Gravity It Mechanical El Audible/visual <br />Inspection type: Violations: <br />*R.uti.e )(Monitoring Certification El Installation El Other: % M I -RDetect El M2-RPrev 0 M-3 Both <br />VIn A ION(S) HSC=Califomia Health & Safety Code; CCR=Califomia Code of Regulations r7V R <br /># <br />Code Section <br />V=Violation; RV=E�2eat Violation <br />V <br />1 <br />I <br />HSC 25284 <br />Permit to operate <br />2 <br />2 <br />CCR 2637 <br />Second m containment test performed <br />3 <br />CCR 2711 (b) & (c) <br />Current Unified Program Consolidated Forms on file with EHD (Facility and tank form) <br />4 <br />HSC 25292.2 <br />Certification of financial res onsibili!y and CFO letter <br />5 <br />CCR 2632 (b) <br />Monitoring Program (Monitorin &Res onse Plan) is current and approved by the local Mency. <br />6 <br />CCR 2712 (i) <br />Monitoring plan is onsite. <br />7 <br />CCR 2712 (b) <br />Maintenance & monitoring records <br />(Mi) Vol <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 monitorin system is present <br />(Mi) <br />11 <br />CCR 2630 (d) <br />UST system monitorin ui mentis EMjno erly located to detect a leak <br />(Mi) <br />----(M2) <br />72 <br />HSC 25291(b) <br />UST system monitorin uipment isoperati nal <br />13 <br />CCR 2636 (f)(1) <br />Continuous monitoring system for underground piping & UDC is present <br />14 <br />CCR 2631 (a) <br />Primarycontainment is roduct ti ht <br />15 <br />1 HSC 25291 (a)(2) <br />Second 2a containment for UST is tight <br />16releases <br />in secondary piping flow to a collection sump <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 />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 & pro2erly disposed of <br />22 <br />CCR 2650 <br />Recordin r orting of unauthorized releases <br />(Ml) <br />23 <br />CCR 2715 <br />Desi ated Operator: (a) Statement from U cl- eMonthlins pection;ff' )�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 />CR 2636 (f)(4) <br />Annual line tightness test <br />(i) <br />CCR 2661 (f) <br />Repair for tank/piping has had tightness test <br />(M2)CCR <br />F27 <br />2643 (e) <br />Biennial tightness test of Eavity piping (pre -January 1, 1984) <br />CCR 2643 (d) <br />Triennial line test for conventional suction piping (pre -January 1, 1984) <br />(i) <br />HSC 25292.5 <br />Double wall system located within 1000' of public well-ELD <br />32 <br />CCR 2661 <br />Permit to rei)air UST system <br />33 <br />HSC 25286 (a) <br />Permit to alter monitoring system <br />34 <br />HSC 25298 (b) <br />Permit to tenporarily close UST system <br />35 <br />1 HSC 25298 (c) <br />Permit to close UST system <br />36 <br />1 HSC 25299 (a)(9) <br />Disablin leak detection devices <br />37 <br />HSC 25298 (a) <br />I Illegal abandonment of UST system <br />38 1 Other: <br />EHD INSPECTOR: PHONE: Am Sotic system. UIC <br />W& JIV14 , —(!2 -011,11,J 7 Serves �t2O people/day <br />kECEIVED BY.- TITLE: F, Receives other than sanitary waste <br />Other diMosal methods: <br />Ac..'n wells/French Drains <br />EHD 23-02-002 REV 05/07 <br />