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NNW - <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton,California 95202-3029 <br /> Telep ne:(209)468-3420 Fax:(209)468-3433 Web:www.sjQov.org/ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: i Inspection Date: <br /> Facility address: _ UST# <br /> 0-4 <br /> '' Product <br /> Facilitv Contact: Title: Phone: , <br /> Monitoring Panel: Piping syst m: Overfill prevention: <br /> ❑Pressurized ❑Suction ❑Gravity ❑Mechanical OAudible/visual <br /> Inspection type: Violations: <br /> ❑Routine ❑Monitoring Certification ❑Installation ❑Other: ❑MI-RDetect ❑M2-RPrev ❑M-3 Both <br /> # Code Section <br /> VIOL. TIONS) HSC=California Health&Safety Code;CCR=California Code of Regulations V R V=Violation;RV=Rcpeat Violation V <br /> 1 HSC 25284 Permit to erate <br /> 2 CCR 2637 Seconda containment test performed <br /> 3 CCR 2711 b)& c Current U ified Program Consolidated Forms on file with EHD(Facility and tank fonif <br /> 4 1 HSC 25292.2 Certificati n of financial responsibility and CFO letter <br /> 5 CCR 2632 b) Monitorin Program Monitorin &Response Plan is current and approved by the local agency.c31t6 CCR 2712 i Monitorin plan is onsite. <br /> 7 CCR 2712 b Maintenan e&monitoring records M1 <br /> 8 CCR 2643 d) O, aily mon toring of suction piping(pre-January, I, 1984) <br /> 9 HSC 25292.1 UST s ste i isoperated to prevent unauthorized release <br /> 10 CCR 2632 c)(2) UST moni oring system is present (M I) <br /> 11 CCR 2630 d UST s ste i monitoring eq ui ment is properly located to detect a leak (M l) <br /> 12 HSC 25291 b) UST syste#1 monitoring equipment isoperational (M2) <br /> 13 CCR 2636 l Continuouj monitoring system for underground piping&UDC is present (M 1) <br /> 14 CCR 2631 a) Primary co tainment is product tight <br /> 15 HSC 25291 (a)(2) Seconda ontainment for UST is tight <br /> 16 CCR 2636(c)(1) All release in secondary piping flow to a collection sum <br /> 17 HSC 25291 t) Line leak c -tector(s)are installed M 1 <br /> 18 CCR 2635(b)(1) $ illcont a er (M2) <br /> 19 CCR 2635(b)(2) Overfill pr vention system (M2) <br /> 20 CCR 2636(a) Conventioi al suction piping shall have continuous monitoring&2°containment <br /> 21 HSC 25291 (e) Water in 2 containment analyzed&properly disposed of <br /> 22 CCR 2650 Recording/-eporting of unauthorized releases (M1) <br /> 23 CCR 2715 Designate Operator:(a)Statement from UST owner; (c-e)Monthly inspection; t)Employee training <br /> 24 CCR 2638 a Annual mo iitoring certification <br /> 25 CCR 2638(a) Annual lin leak detector test (M 1 <br /> 26 HSC 25284.2 Annuals it containment testing <br /> 27 CCR 2636(f)(4) Annual lint tightness test Ml <br /> 28 CCR 2661 (f) Repair for ink/piping has had tightness test (M2) <br /> 29 CCR 2643 e) Biennial ti itness test of gravity pipingre-Janus 1, 1984) <br /> 30 CCR 2643 d) Triennial li a test for conventional suction piping( re-Janus I, 1984) (M1) <br /> 31 HSC 25292.5 Double wal system located within 1000'of public well-ELD <br /> 32 CCR 2661 Permit to r air UST system <br /> 33 HSC 25286 a Permit to al er monitoring system Cj <br /> 34 HSC 25298 b) Permit to tenporarily close UST system COVERED <br /> 35 HSC 25298 c) Permit to close UST system PER _ <br /> 36 HSC 25299(a)(9) Disabling leak detection devices mms _ <br /> 37 HSC 25298 a) I Ileal aban onment of UST s stem _ <br /> 38 Other: <br /> EHD INSPECTOR: PHONE: UIC <br /> n,z s t--"I <br /> Septic system: <br /> —Serves»0 people/day <br /> RECEIVED BY: T IT L i:: —Receives other than sanitary waste <br /> Other disposal methods: <br /> Dry wells/French Drains <br /> RECEIVED JUN 242008 RECEIVED JUN 2 6 20086-,\ <br /> EHD 23-02-002 REV 05/07 <br />