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SAN JOAQUIN COUNTY <br /> ONVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,California 95202-3029 <br /> Telephone:(209)468-3420 Fax. (209)468-3433 Web:www.sigov.or <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> UAI %ell W+(N1 <br /> Facility ad rens: UST# <br /> Wk* Date: <br /> 00-1 Ll I <br /> Product Pies-e <br /> Facility eontact: Title: Phone: <br /> Vim <br /> onitoring nel- Piping system: 7 POverrfill Orevention: <br /> 14 Ik <br /> Pressurized [I Suction El Gravity Mechanical El Audible/visual <br /> Inspection pe: I I Violations: <br /> CkRoutine Monitoring Certification El Installation El Other: IL 0 M I-RDetect El M2-RPrev El M-3 Both <br /> odI LATION(S) HSC=California Health&Safety Code;CCR=California Code of Regulations <br /> # Ce Section V <br /> I V=Violation;RV=Repeat Violation <br /> I HSC 25284 Permit too erste <br /> 2 CCR 2637 Secondary containment test performed <br /> 3 CCR 2711 (b)& c) Current Unified Program Consolidated Forms on file with EHD ffacili!y and tank form) <br /> 4 HSC 25292.2 Certification of financial responsibility and CFO letter <br /> 5 CCR 2632(b) Monitoring Program(Monitoring&Response Plan)is current and approved by the local agency. <br /> 6--TCCR 2712 i) Monitorin lan is onsite. <br /> 7 CCR 2712(b) Maintenance&monitorin records I) <br /> CN <br /> CCR 2643(d) Daily monitorin&2LLsu�ct ��ary, 1, 1984) <br /> 9 HSC 25292.1 UST system isoperated to prevent unauthorized release <br /> 10 CCR 2632(c)(2) UST mo (Mi) <br /> 11 CCR 2630(d) leak (Mij <br /> HSC 25291 (b) UST system monitoring Equipment isoperational (M2)._ <br /> 13 CCR 2636(f)(1) Continuous monitoring system for undgEound piping&UDC is present (Mi) <br /> 12N 7;V <br /> 14 1 CCR 2631 (a) Primary containment is.roduct tight <br /> 15 1 HSC 25291 (a)(2) Secondary containment for UST is tight <br /> 16 CCR 2636 c)(1) All releases in secondary piping flow to a collection sump (Mi) <br /> 17 HSC 25291 (f) Line leak:detector(s)are installed <br /> 18 CCR 2635(b)(1) Spill container (N12) <br /> 19 CCR 2635(b)(2) Overfill prevention system (M2) <br /> 20 CCR 2636(a) Conventional suction piping shall have continuous monitoring&2'containment <br /> 21 HSC 25291 (e) Water in 20 containment analyzed <br /> 22 CCR 2650 RecordinarMorting of unauthorized releases (Mi) <br /> 23 CCR 2715 Designated 2perator:(a)Statement from UST owner; (c-e)Monthly inspection;(f)Employee training <br /> 24 -CCR 2638(a) Annual monitorin certification <br /> (Mi) <br /> 25 CCR 2638(a) Annual line leak detector test <br /> 26 1 HSC 25284.2 Annuals ill containment testin <br /> 27 CCR 2636(f)(4) Annual line (MI) <br /> 28 CCR 2661 (f) !LTair for tank/ i in has had tightness test (M2) <br /> 29 CCR 2643(e) Biennial tightness test of gravity piping(2re-Janus ry 1, 1984) <br /> 30 CCR 2643(d) Triennial line test for conventional suction piping(pre-January 1, 1984) (Mi) <br /> 31 HSC 25292.5 Double wall astem located within 1000' <br /> 32 CCR 2661 Permit to repair UST system <br /> 33 HSC 25286(a) Permit to alter monitoring system <br /> 34 HSC 25298(b) Permit to temporarily close UST system <br /> 35 HSC 25298(c) Permit to close UST system <br /> 36 1 HSC 25299 a) Disabling leak detection devices <br /> 37-1 HSC 25298(a) -1saal abandonment of UST system <br /> 38 1 Other: <br /> 'rINSkECTOR: PHONE: Septics sUtern: UIC <br /> u� (11A) LM-, -]Serves 210 people/day <br /> 280 <br /> RECEIVED BY.' TITLE: 7E Receives other than sanitary waste <br /> Other disposal methods: <br /> Dry wells/French Drains <br /> EHD 23-02-002 REV 05/07 <br />