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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.siaov.or-q/ehd <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection <br /> Ar(., <br /> .vf.2W &j 6t . <br /> Date: <br /> MAIC,V- &Tbp A 6,;ir PA sr 6117 Lo� <br /> Facility address: <br /> UST# <br /> PON --Product <br /> Facility Contact: <br /> Title: Phone: <br /> 4 <br /> Pil <br /> Monitorihg Panel: Piping system: Overfill prevention: <br /> 14 <br /> , A 1 SA-Alf-Lb EW C are;surized 0 Suction 0 Gravity "echanical 0 Audible/visual <br /> 'Violations: <br /> Inspection type: <br /> (3M <br /> W(butine al0ionitoring Certification 0 Installation 0 Other: 0 Ml-RDetect 0 M2-RPrev 0 M-3 Both <br /> # Code Section VIOLATION(S) HSC=Califomia Health&Safety Code;CCR=Califomia Code of Regulations VTR <br /> 1 HSC 25284 Permit toerate V=Violation;RV=Repeat Violation v <br /> 2 CCR 2637 Secondary containment test performed <br /> 3 CCR 2711 (b)&(c) Current Unified Pro ram Consolidated Forms on file With EHD(Facility and tank form) <br /> 4 HSC 25292.2 Certification of financial responsibility and CFO letter <br /> 5 CCR 2632(b) Monitoring Program(Monitoring&Response Plan)is current and approved by the local agency. <br /> 6 CCR 2712(i) Monitoring plan is onsite. <br /> 7 CCR 2712(b) Maintenance&monitoring records (MI) <br /> 8 CCR 2643(d) Daily monitoring of suction piping(pre-January, 1, 1984) <br /> 9 HSC 25292.1 LIST system isoperated to prevent unauthorized release <br /> 10 1 CCR 2632(c)(2) LIST monitoring system is resent (Mi) <br /> 11 CCR 2630(d) LIST system monitoring equipment is properly located to detect a leak M1 <br /> 12 HSC 25291 (b) UST system monitoring equipment isoperational (MI) <br /> 13 CCR 2636(f)(1) Continuous monitoring system for underground piping&UDC is present (MI) <br /> 14 CCR 2631 (a) Primary containment is product tight <br /> 15 HSC 25291 (a)(2) Secondary containment for LIST is tight <br /> 16 CCR 2636(c)(1) All releases in secondary piping flow to a collection sump <br /> 17 HSC 25291 (f) Line leak detector(s)are installed (MI) <br /> 18 CCR 2635(b)(1) Spill container <br /> 19 CCR 2635(b)(27) Overfill prevention system (MI) <br /> 20 CCR 2636(a) Conventional suction piping shall have continuous monitoring&20 containment (M2) <br /> 21 HSC 25291 (e) Water in 20 containment analyzed&properly disposed of, <br /> 22 1 CCR 2650 Recording/reporting of unauthorized releases M1 <br /> 23 CCR 2715 Designated Operator:(a)Statement from LIST owner; (c-e)Monthly inspection;(f)Employee training <br /> 24 CCR 2638(a) Annual monitoring certification <br /> 25 CCR 2638(a) Annual line leak detector test _(MI) <br /> 26 HSC 25284.2 Annual spill containment testing <br /> "27 CCR 2636(1)(4) Annual line,tightness test (MI) <br /> 28 CCR 2661 (f) _ Repair for tank/pi in has had tightness test (M2) <br /> 29 CCR 2643(e) Biennial tightness test of gravity piping(pre-Januar <br /> y 1, 1984) <br /> 30 CCR 2643(d) Triennial line test for conventional suction piping(pre-January 1, 1984) <br /> 31 HSC 25292.5 Double wall system located within 1000'of public well-ELD (MI) <br /> 32 CCR 2661 Permit to repair LIST system <br /> 33 HSC 25286(a) Permit to alter monitoring system <br /> 34 HSC 25298(b) Permit to temporarily close UST system <br /> 35 HSC 25298(c) Permit to close UST system <br /> 36 HSC 25299 Disabling leak detection devices <br /> — (a)(9)(0(2) <br /> 37 HSC 25298 a Ille al abandonment of UST system <br /> 38 Other. <br /> EHD INSPECTOR: ( PHONE:: 1.11C <br /> W'&\ <br /> V <br /> RECEIVED BY: D Serves 20people/day <br /> TITLE: 0 Receives other than sanitary waste <br /> Other disposal methods: <br /> 0 D%wells/French Drains <br /> EHD 23-02-002 REV 8/08 <br />