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1 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, California 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sigov.orci/ehd/unitiii.htmi <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br /> Facility i n Facility , Inspection i <br /> Name: �: ddress: 5G �. �` ate: <br /> Facility Title: Phone: <br /> Contact: <br /> Inspection <br /> Type: Xoutinex,Monitoring System Certification Installation �Complaint-ID#: -1Other: <br /> (Authority HSC 25289) � <br /> Consent for: nspection ❑Sampling Xhotos Granted by: Title: <br /> Monitoring Piping Overfill <br /> Panel: <br /> c` ressurized Suction Gravity *echanical ❑Audible/visual <br /> ��y �.ZZ,� System: Prevention: <br /> UST <br /> -: S f - - ------------ - - - - - - - -------------- -------------- -------------- ------------ -------------- <br /> Designated J'i l ICC Exp. <br /> Operator. .N 6e_'f Date: f Violations: M1-Release Detection M2 Release Prevention 7M3-Both <br /> On Site Service ICC Exp. Manufacturer's <br /> Technician: �` 1�r'G�Yl1�f�1% Date: { Training: !h b <br /> VIOLATIONS <br /> # C1 C2 M Code Section HSC=California Health and Safety Code;CCR=California Code of Regulations <br /> Cl=Class 1 violation;C2=Class 2 violation;M=Minor violation <br /> 101 HSC 25284 No permit to operate <br /> 102 HSC 25404.5 Annual operating fees not paid <br /> 103 HSC 25284(a)(3) No written agreement between the person that the operating permit was issued to and the tank operator to <br /> monitor the tank system <br /> 104 HSC 25292.2 Current financial responsibility documents not on file with the Environmental Health Department(EHD) <br /> 105 CCR 2711 Current Unified Program Consolidated Forms not on file with the EHD(Facility and tank form) <br /> 106 CCR 2632(b) Monitoring Program(Monitoring&Response Plans)is not current or approved by the EHD <br /> 107 CCR 2632(d)(1)(C) Plot plan/site map not submitted or fails to completely show where monitoring is performed <br /> 108 CCR 2637 Secondary containment:(a)test not performed;(e)test report not submitted within 30 days;(f)test notification <br /> not provided to the EHD at least 48 hours prior to conducting the test <br /> Monitoring equipment certification:(a)not performed annually;(d)test report not submitted within 30 days; <br /> 109 CCR 2638 (e)test notification not provided to the EHD at least 48 hours prior to conducting an installation,repair, <br /> replacement,calibration,or certification <br /> 110 HSC 25291(f) Annual line leak detector test not performed (M1) <br /> 111 HSC 25284.2 Annual spill containment testing not performed <br /> 112 CCR 2636(f)(4) Annual line tightness test not performed if positive shutdown or fail safe not present (M1) <br /> 113 CCR 2715(a) Failed to inform the EHD of a change of designated operator within 30 days <br /> 114 CCR 2715(b) Designated operator does not possess a current ICC CA UST System Operator certification <br /> 115 CCR 2660(k) Repair for tank or piping not tested for tightness after completion of the repair pursuant to (M2) <br /> permit conditions <br /> 116 HSC 25292.5 Enhanced leak detection(ELD)testing not performed on a system located within 1 000'of public well,or <br /> failures not repaired and retested <br /> 117 CCR 2661 Permit to repair UST system not obtained <br /> 118 HSC 25286(a) Operational permit not amended when UST storage and/or monitoring system changed <br /> 119 HSC 25298(b) Permit to temporarily close UST system not obtained <br /> 120 HSC 25298(c) Permit to close UST system not obtained <br /> P; <br /> Maintenance&monitoring records not maintained 3 years,cathodic protection records"for 6 Y2 years,written <br /> performance claims pertaining to release detection systems for 5 years,or records of repairs,linings,and <br /> 201 CCR 2712(b) upgrades for the life of the tank. Monitoring records include:(1)date and time of all monitoring or sampling; <br /> (2)monitoring equipment calibration and maintenance records;(3)results of any visual observations;(4) <br /> results of sample analysis performed a lab or in the field;(5)logs of all readings of gauges or other monitoring <br /> equipment,ground water elevations,or other test results; 6 results of inventory readings and reconciliations <br /> 202 1 1 1 1 CCR 2712(i) Monitoring plan,response plan,and/or operating permit and all conditions not onsite <br /> Unauthorized release that:(c)did not escape secondary containment and cleaned up within eight hours (M7) <br /> 203 CCR 2650 was not recorded;(e)escaped secondary containment,not cleaned ul after eight hours,or a sudden loss of <br /> product was not reported to the EHD within 24 hours <br /> Inspector: Receiv dB Tide: <br /> EHD 23-02 Rev 1/11 Page 1 UST INSPECTION REPORT <br />