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0 SAN JOAQUIN COUNTY is <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, California 95202-3029 <br />Telephone: (209) 468-3420 Fax.- (209) 468-3433 Web: www.sigoy.orelid <br />Facility name: <br />Designated Operator: <br />ryWe- ,,AB <br />Inspection Date: <br />Facility address: <br />N Al <br />® <br />r - <br />UST # <br />Product <br />Facility Contact: Title: Phone: <br />A,4v q43-ir4t3 <br />Monitoring Panel: <br />V!9 <br />Piping 'system: <br />J4'essurized El Suction El Gravity <br />Overfill prevention: <br />M chanical [Audible/visual <br />e <br />Inspection type: Violations: <br />outine monitorngCerifcation EInstallation EOther: MI-RDetect 11 M2-RPrev <br />>Mr <br /># Code Section VIOLATION(S) HSC=Califomia Health & Safety Code; CCR=Califomia Code of Regulations <br />V=Violation; RV=Repeat Violation <br />El M-3 Both <br />V R <br />V <br />I <br />HSC 25284 — <br />Permit too2erate <br />2 <br />CCR 2637 — <br />Second2a containment test performed <br />3 <br />4 <br />CCR 2711 (b) & (c) <br />HSC 25292.2 <br />Current Unified Program Consolidated Forms on file with EHD (Facility and tank form) <br />Certification of financial res2onsibility and CFO letter <br />. <br />d <br />5 <br />6 <br />CCR 2632 (b) <br />CCR 2712 (i) <br />Monitoring Program (Monitoring & Response Plan) is current and approved by the local agency. <br />Monitorin plan is onsite._ <br />%T <br />7 <br />CCR 2712 b) <br />Maintenance & monitoring records <br />8 <br />CCR 2643 (d) <br />Daily monitoring of suction ...... I-re-Janua[Z, 1, 1984) <br />9 <br />1 HSC 25292.1 <br />UST system iso2erated to prevent unauthorized release <br />10 <br />1 CCR 2632 c)(2) <br />UST monitoring system is 2resent <br />(M 1) <br />11 <br />CCR 2630 (d) <br />UST system monitoring equipment is 2ro2erly located to detect a leak <br />(M 1) <br />12 <br />13 <br />HSC 25291 (b) <br />CCR 2636 (D(l) <br />UST system monitoring equipment isoperational <br />Continuous monitorinE system for underground piping & UDC is present <br />(M2) <br />(M1) <br />14 <br />CCR 2631 (a) <br />Primary containment is product tiht <br />15 <br />HSC 25291 (a)(2) <br />Secondaa containment for UST is ti ht <br />16 <br />CCR 2636 (c)(1) <br />All releases in secondaa 2iping flow to a collection sum2 <br />17 <br />HSC 25291 (D <br />Line leak detector(s) are installed <br />(M 1) <br />18 <br />CCR 2635 b) 1) <br />Spill container <br />(M2) <br />19 <br />20 <br />21 <br />22 <br />CCR 2635 b)(2) <br />CCR 2636 (a) <br />HSC 25291 (e) <br />1 CCR 2650 <br />Overfill 2revention system <br />Conventional suction 2i2ing shall have continuous monitoring & 2' containment <br />Water in 2' containment analyzed & 2roperly dis2osed of <br />Recording/reporting of unauthorized releases <br />(M2) <br />(M 1) <br />23 <br />CCR 2715 <br />Designated 02erator: (a) Statement from UST owner; c -e) Monthly ins Em21oyEEj2±jna____ <br />24 <br />CCR 2638 (a) <br />Annual monitorinE certification <br />25 <br />CCR 2638 a) <br />Annual line leak detector test <br />(M1) <br />26 <br />HSC 25284.2 <br />Annual s2ill containment testin--.-- <br />27 <br />CCR 2636 f 4) <br />Annual line tiEhtness test <br />(M1) <br />28 <br />29 <br />1 CCR 2661 (f) <br />CCR 2643 (e) <br />Repair for tank/ 2iljin has had tihtness test <br />Biennial tightness test of gravity Eiping (pre-Janua!j 1, 1984) <br />(M2) <br />30 <br />CCR 2643 d) <br />Triennial line test for conventional suction 2ieina (2re-January 1, 1984) <br />(M1) <br />31 <br />HSC 25292.5 <br />Double wall system located within 1000' of 2ublic well-ELD <br />32 <br />33 <br />CCR 2661 <br />HSC 25286 (a) <br />Pen -nit to repair UST system <br />Permit to alter monitoring s stem <br />34 <br />35 <br />1 HSC 25298 (b) <br />HSC 25298 (c) <br />Permit to temporarily close UST system <br />it close UST system <br />to� <br />36 <br />HSC 25299 (a)(9) <br />DisablinE leak detection devices <br />37 <br />HSC 25298 a) <br />Illegal abandonment of UST <br />38 <br />Other: <br />.system <br />I <br />ME <br />PHONE-Z.1Z87—'Z"?10 <br />RECEIVED BY: <br />EHD 23-02-002 REV 05/07 <br />Septic <br />Serves >-20 people/day <br />Receives other than sanitary waste <br />Other disposal methods: <br />- Dry wells/ French Drains <br />