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SAN JOAQUIN COUNTY <br /> *ENVIRONMENTAL HEALTH DEPARTMENO <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax: (209)468-3433 Web:www.sogov.org/ehd <br /> UNDERGROUND STORAGE TANK UST PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator:Exp.Date: Inspection Date: <br /> COUNTRYSIDE MINI MART THOMAS HINGSTON 04/03108 <br /> 12/28/08 <br /> Facility address: TANK#4 TANK#5 TANK#6 TANK# <br /> 14971 N HWY 88 <br /> Gasoline 91 <br /> Facility Contact: Title: Phone: TANK# TANK# TANK# TANK# <br /> KASHMIR SINGH OWNER 368-5380 Product Product <br /> Monitoring Panel: Piping system: Overfill prevention: <br /> VR TLS-350 ®Pressurized ❑Suction ❑Gravity ®Mechanical ❑Audible/visual <br /> Inspection type: Violations: <br /> ®Routine ®Monitoring System Certification ❑Installation ❑Other: ®M1-RDetect ❑ M2-RPrev ❑ M-3 Both <br /> # Code Section VIOLATION(S) HSC=California Health&Safety Code;CCR=California Code of Regulations V R <br /> V=Violation; RV=Re eat Violation V <br /> 1 HSC 25284 Permit tooperate ❑ ❑ <br /> 2 CCR 2637 Secondary containment test performed ❑ ❑ <br /> 3 CCR 2711 b & c Current Unified Program Consolidated Forms on file with EHD(Facility,Tank, Monitoring/Response) ❑ ❑ <br /> 4 1 HSC 25292.2 Certification of financial responsibility and CFO letter ❑ ❑ <br /> 5 CCR 2632 c 2 D Monitoring&response plan is current and filed with the local agency <br /> ❑ <br /> 6 CCR 2712 i Monitoring&response plan is onsite ❑ <br /> 7 CCR 2712 b Maintenance&monitoring records M1 ® ❑ <br /> 9 HSC 25292.1 UST system isoperated to prevent unauthorized release ❑ ❑ <br /> 10 CCR 2632(c)(2) UST monitoring system is present (MIL ❑ ❑ <br /> 11 CCR 2630 d UST system monitoring equipment is properly located to detect a leak M1 ❑ ❑ <br /> 12 HSC 25291 b UST s stem monitoring equipment isoperational M2 ❑ ❑ <br /> 13 CCR 2636 1 Continuous monitoring system for underground piping&UDC is present M1) ❑ <br /> 14 CCR 2631 a Primary containment is product tight ❑ ❑ <br /> 15 HSC 25291 (a)(2) Secondary containment for UST is tight ❑ ❑ <br /> 16 CCR 2636(c)(1) All releases in secondary pipingflow to a collection sump ® ❑ <br /> 18 CCR 2635(b)(1) Spill container (M2) ❑ ❑ <br /> 19 CCR 2635(b)(2) Overfill prevention system (M2) ❑ ❑ <br /> 21 HSC 25291 (e) Water in 211 containment analyzed&properly disposed of ❑ ❑ <br /> 22 CCR 2650 Recording/reporting Recording/reportingof unauthorized releases (M1) ❑ ❑ <br /> 23 CCR 2715 Designated Operator: a Statement from UST owner; (c-e)Monthly inspection; Employee training ® ❑ <br /> 24 CCR 2638 a Annual monitoring certification ❑ ❑ <br /> 25 CCR 2638 a Annual line leak detector test M1) ® ❑ <br /> 26 HSC 25284.2 Annuals ill containment testing ❑ ❑ <br /> 27 CCR 2636 4 Annual line tightness test (M1) ❑ <br /> 28 CCR 2661 Repair for tank/piping has had tightness test (M2) ❑ ❑ <br /> 31 HSC 25292.5 Double walls stem located within 1000'of public well-ELD ❑ ❑ <br /> 32 CCR 2661 Permit to repair UST system ❑ ❑ <br /> 34 HSC 25298 b Permit to temporarily close UST system ❑ ❑ <br /> 36 HSC 25299(a)(9) Disabling leak detection devices ❑ ❑ <br /> 37 HSC 25298 a Illegal abandonment of UST system ❑ ❑ <br /> 38 CCR 2638(d) Monitoring system certification test report submitted within 30 days. ❑ ❑ <br /> 39 CCR 2637(e) Secondary containment test report submitted within 30 days. ❑ ❑ <br /> 40 HSC 25290.1 Secondary containment prevents any water intrusion after July 1,2004 ❑ ❑ <br /> 41 HSC 25290.2 Secondary containment prevents any water intrusion after July 1,2003 and before July 1,2004 ❑ ❑ <br /> 38 Other: ❑ ❑ <br /> ❑ ❑ <br /> ❑I ❑ <br /> EHD INSPECTOR: PHONE: Septics stem: UIC <br /> Ray von Flue 209 468-9848 ®Serves>_20 people/day <br /> RECEIVED TITL El Receives other than sanitary waste <br /> ther dis I methods: <br /> ❑ <br /> Dry wells/French Drains <br /> EHD 23-02-002 Pagel <br /> 3/13/2008 <br />