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SAN JOAQUIN COUNTY 410110 <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.org/ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: <br /> Designated Operator: Inspection Date: <br /> %Rl7UG(AfG R41A�N �ut�rlc sla7/oV <br /> Facility address: <br /> UST# <br /> ' � �� <br /> Product 0S <br /> Facility Contac[: Title: Phone: <br /> MOW- Itcocl� Wi 28 ri e*Z 1 b <br /> Monitoring Panel: Piping system: Overfill prevention: <br /> / ✓S 3� pressurized ❑Suction ❑Gravity Mechanical ❑Audible/visual <br /> Inspection type: --// Violations: <br /> Koutine LWMonitoring Certification ❑Installation ❑Other: I ❑M I-RDetecl ❑M2-RPrev ❑M-3 Both <br /> VIOLATION(S) HSC-California Health&Safety Code;CCR�alifomia Code of Regulations V R <br /> # Code Section g <br /> V=Violation; RV=Repeat Violation V <br /> I 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 and tank form) <br /> 4 HSC 25292.2 Certification of financial responsibility and CFO letter <br /> 5 CCR 2632 6 MonitoringPro ram Monitorin &Response Plan)is current and approved by the local agency. <br /> 6 1 CCR 2712 i) Monitoring plan is onsite. <br /> 7 CCR 2712 6 Maintenance&monitoringrecords MI t/ <br /> 8 CCR 2643 d) Daily monitoring of suction piping(pre-January, 1, 1984) <br /> 9 HSC 25292.1 UST system isoperated to prevent unauthorized release <br /> 10 CCR 2632 c)(2) UST monitoring system is present (M 1) <br /> I I CCR 2630 d UST system monitoring equipment is properly located to detect a leak M 1) <br /> 12 HSC 25291 b) UST system monitoring equipment isoperational (M2) <br /> 13 CCR 2636(t)(1) Continuous monitoring system for underground piping&UDC is present (MI <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)(I) All releases in secondarypiping flow to a collection sum <br /> 17 HSC 25291 t Line leak detecto s)are installed M 1) <br /> 18 CCR 2635(b)(1) Sill container (M2) <br /> 19 CCR 2635(b)(2) Overfill reventionsystem M2) <br /> 20 CCR 2636(a) Conventional suction piping shall have continuous monitoring&2a containment <br /> 21 HSC 25291 (e) Water in 20 containment analyzed&properly disposed of <br /> 22 CCR 2650 Recording/reportingof unauthorized releases Ml) <br /> 23 CCR 2715 Designated Operator: (a)Statement from UST owner; e)Monthlyinspection; t)Employee training <br /> 24 1 CCR 2638 a Annual monitoring certification <br /> 25 CCR 2638(a) Annual line leak detector test (MI) <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636(f)(4) Annual line tightness test MI) <br /> 28 CCR 2661 t) Repair for tank/pipinghas had tightness test (M2) <br /> 29 CCR 2643 e) Biennial tightness test of gravitypiping(pre-January1, 1984) <br /> 30 CCR 2643 d) Triennial line test for conventional suction piping(pre-January 1, 1984) MI) <br /> 31 HSC 25292.5 Double walls stem located within 1000' of public well-ELD <br /> 32 CCR 2661 Permit to re air UST system <br /> 33 1 HSC 25286 a) Permit to alter monitorings stem <br /> 34 HSC 25298 b) Permit to temporarily close UST system <br /> 35 HSC 25298 c) Permit to close UST system <br /> 36 HSC 25299(a)(9) Disabling leak detection devices <br /> 37 HSC 25298 a) I Illegal abandonment of UST system _ <br /> 38 Other: <br /> EHD INSPECTOR: PHONE: UIC <br /> Seo[c svm <br /> tj 11 � 5 (T Tef Serves <br /> >_20 people/day <br /> RECEI BY: LE: C— -Receives other than sanitary waste <br /> �Gv Other disposal methods <br /> -Dry wells/French Drains <br /> EHD 23-02-002 REV 05/07 <br />