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SAN JOAQUIN COUNTY <br />as9VIRONMENTAL HEALTH DEPARTMENT <br />304 EWeber Avenue, 3`d Floor, Stockton, CA 9520 - 708 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sj og v.or / <br />UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br />Facility name: <br />Designated Operator: <br />Inspection Date: <br />Facility add��ress <br />W <br />UST # I <br />Product <br />�( <br />Facility Contact: <br />Title: 0Phone: <br />Monitoring Panel: <br />r <br />rC�ajtiI*ressurized <br />Piping system: <br />❑ Suction ❑ Gravity <br />Overfill prevention: <br />Mechanical ❑ Audible/visual <br />Inspection type: <br />Yltoutine Monitoring Certification ❑ Installation ❑ Other: <br />'Violations: <br />❑ M1-RDetect ❑ M2-RPrev <br />❑ M-3 Both <br /># <br />Code Section <br />VIOLATION(S) HSC=California Health & Safety Code; CCR=California Code of Regulations <br />V=Violation; RV=Re eat Violation <br />V R <br />V <br />I <br />HSC 25284 <br />Permit tooperate <br />2 <br />CCR 2637 <br />Secondary containment test performed <br />3 <br />CCR 2711 b & c) <br />Current Unified Program Consolidated Forms on file with EHD(Facility and tank form <br />4 <br />HSC 25292.2 <br />Certification of financial responsibility and CFO letter <br />5 <br />CCR 2632 c 2 (D) <br />Monitoring & response plan is current and filed with the local agency <br />6 <br />CCR 2712 (i) <br />Monitoring & response plan is onsite <br />7 <br />CCR 2712 b <br />Maintenance & monitoring records <br />(MI) <br />8 <br />CCR 2643 (d) <br />Daily monitoring of suction'' piping (pre -January, 1, 1984) <br />9 <br />1 HSC 25292.1 <br />UST system isoperated to prevent unauthorized release <br />10 <br />CCR 2632 (c)(2) - <br />UST monitoring system is present <br />(MI) <br />11 <br />CCR 2630 (d) <br />UST system monitoring equipment is properly located to detect a leak <br />(MI) <br />12 <br />HSC 25291 b <br />UST system monitoring equipment is operational <br />M2) <br />13 <br />CCR 2636 (f)(1) <br />Continuous monitoring system for underground piping & UDC is present <br />Ml <br />14 <br />CCR 2631 a <br />Primary containment is product tight <br />15 <br />1 HSC 25291 (a)(2) <br />Secondary containment for UST is ti ht <br />16 <br />1 CCR 2636 (c)(1) <br />All releases in secondary piping flow to a collection sum <br />17 <br />HSC 25291 ( <br />Line leak detector(s) are installed <br />Ml <br />18 <br />CCR 2635 (b)(1) <br />Spill container <br />(M2)_ <br />19 <br />CCR 2635 (b)(2) <br />Overfill prevention system <br />M2 <br />20 <br />CCR 2636 (a) <br />Conventional suction piping shall have continuous monitoring & 2' containment <br />21 <br />HSC 25291 (e) <br />Water in 2° containment analyzed & properly disposed of <br />22 <br />1 CCR 2650 <br />Recording/reporting of unauthorized releases <br />Ml <br />23 <br />CCR 2715 <br />Designated Operator: (a) Statement from UST owner; (c -e) Monthly inspection; (f) Employee training <br />24 <br />CCR 2638 a <br />Annual monitoring certification <br />25 <br />CCR 2638 (a) <br />Annual line leak detector test <br />(MI) <br />26 <br />HSC 25284.2 <br />Annual spill containment testing <br />27 <br />CCR 2636 4 <br />Annual line tightness test <br />(Mi) <br />28 <br />1 CCR 2661 (f) <br />Repair for tank/piping has had tightness test <br />(M2) <br />29 <br />CCR 2643 a <br />Biennial tightness test of gravity piping(re-Janus 1, 1984) <br />30 <br />CCR 2643 (d) <br />Triennial line test for conventional' suction piping (pre -January 1, 1984) <br />(MI) <br />31 <br />HSC 25292.5 <br />Double walls stem located within 1000' of public well-ELD <br />32 <br />CCR 2661 <br />Permit to repair UST system <br />33 <br />HSC 25286 a <br />Permit to alter monitoring system <br />34 <br />1 HSC 25298 (b) <br />Permit to temporarily close UST system <br />35 <br />HSC 25298 c <br />Permit to close UST system <br />36 <br />HSC 25299 (a)(9) <br />Disabling leak detection devices <br />37 <br />HSC 25298 a <br />Illegal abandonment of UST system <br />38 <br />Other: <br />EH <br />NSPETOR: <br />PHONE: UIC <br />7 blsr % g, g otic system: <br />(� �U - Serves 2:20 people/day <br />TITLE: ❑ Receives other than sanitary waste <br />Other disposal methods: <br />�.l�'L-CI��oC.�- ❑ Dry wells/French Drains <br />RE EIVED BY: <br />F a G uss._ � `�g ��rr 2--za <br />/VL'Gj 0 - Z1z 3 to , <br />F.HD 23-02-002 <br />