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s SAN JOAUIN COUNTY INVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, California 95202-3029 Telephone; (209) 468-3420 Fax: (209) 468-3433 Web: www.si oq v•orq/ehd UNDERGROUNDINSPECTION REPORT Facility name: Designatederator: c, 'S. "l- �o �o Inspection Date: _ i® Facility address: — ® UST # ",' uc .' Prodt �'' i' �=1 .' 1'' Facility Contact: Title: Phone: r� 1. " I " Monitoring Panel: Piping system: S ❑ Pressurized Suction ❑ Gravi , Overfill prevention: echanical udible/visual Inspection type: Routine rMonitorin Code Section Violations: Certification ❑ Installation ❑ Other: 1-RDetect ❑ M2-RPrev ❑ M-3 Both VIOLATION(S) HSC=California Health & Safety Code; CCR=California Code of Regulations V R V V=Violation; RV=Re eat Violation 1 HSC 25284 Permit tooperate F2 CCR 2637 Seconda containment test erforme _ 3 CCR 2711 b & c Current Unified Program Consolidated Forms o file with EHD (Facilityand tank form 4 HSC 25292.2 Certification of financial responsibility and CFO letter 5 s CCR 2632 b Monitoring Program(Monitoring & Response Plan is current and approved by the local agency. e CCR 2712 i MonitoringIan is onsite. 7 CCR 2712 b Maintenance monitorin records M1 8 F6 CCR 2643 d Dail monitoringof suction piping (pre -January, 1, 1984 9 HSC 25292.1 UST system isoperated to prevent unauthorized release 10 CCR 2632 (c)(2) UST monitoring system is pLesent M1 11 CCR 2630 d UST system monitoring aqui. ment is properly located to detect a leak M1 12 HSC 25291 b UST system monitoring equipment isoperational M1 13 CCR 2636 1 Continuous monitoring system for underground piping & UDC is present M7 14 CCR 2631 a Primary containment is product tight 15 HSC 25291 (a)(2)___§222ndaa containment for UST is tight 16 CCR 2636 (c)(1) All releases in seconds piping flow to a collection sum 17 HSC 25291 Line leak detectors are installed M1 18 CCR 2635 (b)(1) Spill container 2 19 CCR 2635 b)(2) Overfill prevention system- 2 20 CCR 2636 (a) Conventional suction piping shall have continuous monitoring & 20 containment 21 HSC 25291 (e) Water in 20 containment analyzed & properly disposed of 22 CCR 2650 Recording/reporting of unauthorized releases M1 23 CCR 2715 A Designated Operator: feD Statement from UST owner; - Monthly inspection; Employee training 24 CCR 2638 a Annual monitoring certification 9 -13-0 25 CCR 2638 a Annual line leak detector test 26 HSC 25284.2 Annuals ill containment testingq-( O 27 CCR 2636 4 Annual line ti htness test 1 28 CCR 2661 Reair for tank/ i ing has had ti htness test (M2 29 CCR 2643 a Biennial tightness test of gravity pipingre-Janua 1, 1984 30 CCR 2643 d Triennial line test for conventional suction piping (pre-January1, 1984) 1 31 HSC 25292.5 Double walls stem located within 1000' of public well-ELD 32 CCR 2661 Permit to repair UST system _ 33 HSC 25286 a Permit to alter monitoring system 34 HSC 25298 b Permit to temporarily close UST system 35 HSC 25298 c Permit to close UST system 36 HSC 25299 a 9 2 Disabling leak detection devices 1-1-71 HSC 25298 (a) Illegal abandonment of UST system Septic system: ❑ Serves >_20 people/day C B TITLE: ❑ Receives other than sanitary waste Other disposal methods: ❑ Dry wells/French Drains EHD 23-02-002 REV 8/08