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1 <br />2 CCR 2637 Secondary cont testing (6 <br />month/36 month) <br />3CCR 2711(b) & (c) Current State Forms A & B <br />4/ -HSC 25292.2 Certification of financial <br />responsibility and letter from <br />/ chief financial officer <br />5 V CCR 2630 (d) Continuous monitoring system <br />for UST system <br />6 V CCR 2636 (c)(1) All releases in secondary piping <br />flow to a collection sump <br />7 HSC 25291 (e) Water in secondary (20) cont <br />8 HSC 25291 (f) Automatic line leak detector(s) <br />9 CCR 2636 (f)(1) Continuous monitoring system <br />for underground piping <br />10 CCR 2632 (c)(2) Continuous monitoring system <br />for UST <br />11 HSC 25291(a)(2) Secondary containment for <br />UST is tight <br />12 CCR 2636 (f)(1) Continuous monitoring system <br />for dispenser system <br />13 CCR 2635 (b)(1) Spill container <br />14 CCR 2635 (b)(2) Overfill prevention system <br />15 CCR 2631 (a) Primary containment is product - <br />tight <br />16 HSC 25292.1 UST system is operated to <br />prevent unauthorized release <br />17 CCR 2650 Recording/reporting <br />unauthorized release <br />18�CCR 2632 (d) Monitoring & response plan <br />19 CCR 2712 (i) Monitoring & response plan is <br />on site <br />DATE 7 Z 2 G6 <br />SAN JOAQUIN COUNTY PR# <br />ENVIRONMENTAL HEALTH DEPARTMENT PAGE / Z <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 4 f M MArb+ Facility Address 2 50 ) S+& tzSo,l 4ye-, <br />Facilty Contact /1/ PVP M)1A S eKmtle 0�rWef— Phone # -17 ") / <br />UST# 3 Product rE'P^ UST# H ProductlUicW UST# S Product _UST# Product <br />Overfill Prevention: ❑ AudibleNisual Kmechanical Monitoring Panel: V a TLS")sv <br />Piping System: ❑ Gravity Pressure ❑ Suction Violations: Nminor ❑ Major <br />Automatic Pump Shut Down Satisfies CCR 2636 (g): ❑ Yes)( No Dispenser Pan: V Yes ❑ No R,, ave <br />INSPECTION TYPE <br />COMPANY NAME: Ft 02m <br />)Monitoring Certification []Complaint ❑Install ❑Removal ❑Repair/Upgrade <br />� <br />I V TECHNICIAN NAME: DAd /V Ac Y*) PHONE: $'UD 3Y <br />VIOLATION(S) <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 />HSC 25284 Permit to operate 1 20 V CCR 2712 (b) Maintenance & monitorin <br />9 <br />records <br />21 V CCR 2636 (f)(4) Annual line tightness test <br />22 CCR 2630 (d) Annual line leak detector test <br />23 CCR 2630 (d) Annual monitoring certification <br />24 CCR 2643 (d) Daily monitoring of suction <br />piping that is not continuously <br />monitored <br />25 CCR 2636 (a) Conventional suction piping <br />shall have continuous <br />monitoring & 20 containment <br />26 CCR 2643 (e) Biennial tightness test of gravit <br />piping that is not continuously <br />monitored <br />27 CCR 2662 Upgrade requirements for UST <br />system <br />28 CCR 2661 Permit to repair UST system <br />29 HSC 25286 (a) Permit to alter monitoring <br />system <br />30 HSC 25298 (a) Illegal abandonment of UST <br />system <br />31 HSC 25298 (b) Permit to temporarily close US' <br />system <br />32 HSC 25298 (c) Permit to close UST system <br />33 HSC 25291 (e) Water in 20 cont analyzed and <br />properly disposed of <br />34 CCR 2640 (e) Single wall component within <br />1000' of Public Well, no ELD <br />35 CCR 2635(a)(2)(A) Cathodic protection testing <br />36 H&SC 25299(a)(9) Disabling leak detect. devices <br />37 Violation(s) not listed above <br />EHD INSPECTOR: Ui�-J kwj--� PHONE: 4 6 �- GI 9 Lf i <br />RECEIVED BY: <br />UNITNUST/INSP (rev 724/02) <br />TITLE: <br />