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e'M Pp, ° SAN JOAQUIN COUNTY <br /> MAO�IRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3d Floor, Stockton, CA 95202-2708 <br /> a• p Telephone:(209)468-3420 Far.(209)464-0138 Web:www.sjgov.org/ehd <br /> .'9C%FORNs <br /> UNDERGROUND STORAGE TANK UST PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> 6�WS &AMS toE k AN RvUfJr.Ac 5(410'7 <br /> Facility address: UST# <br /> 1611 S Aa boa wa-l1 srvr�cTONZ <br /> Product <br /> Facility Contact: Title: Phone: <br /> 0 Nit 4ArW"X4 M^#W (2-0,9) l , <br /> Monitoring Panel: P—i/ping system: Overfill prevention: <br /> I� LS I3 Pressudzed ❑Suction ❑Gravi __ CN(Nechanical ❑Audible/visual <br /> Inspection type: // Violations: <br /> �outine Li4enitorin Certification ❑Installation ❑Other: L Ml-RDetect ❑M2-RPrev L M-3 Both <br /> # Code Section <br /> VIOLATIONS) HSC=California Health&Safety Code;CCR=Califomia Code of Regulations V R V=Violation;RV=Re eat Violation V <br /> 1 HSC 25284 Permit to operate <br /> 2 CCR 2637 Second containment test performed <br /> 3 CCR 2711 6 & c Current Unified Pro ram Consolidated Fomes on file with EHD(Facility and tank form <br /> 4 HSC 25292.2 Certification of financial responsibility and CFO letter <br /> 5 CCR 2632(c)(2) D Monitoring&response plan is current and filed with the local agency <br /> 6 CCR 2712 i Monitoring&response plan is onsite <br /> • <br /> CCR 2712 Maintenance&monitoring records I <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 M7 <br /> 11 CCR 2630 d UST system monitoring equipment is properly located to detect a leak Ml <br /> 12 HSC 25291 UST system monitoring equipment isoperational M2 <br /> 13 CCR 2636 (1) Continuous monitoring system for underground piping&UDC is present Ml <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)(1) All releases in secondary pipingflow to a collection sump <br /> 17 HSC 25291 Line leak detector(s) are installed Ml <br /> 18 CCR 2635 1 Spill container M2 <br /> 19 CCR 2635 2 Overfill prevention system (M2) <br /> 20 CCR 2636(a) Conventional suction piping shall have continuous monitoring&20 containment <br /> 21 HSC 25291 (e) Water in 2°containment analyzed&properly disposed of <br /> 22 CCR 2650 Recording/reporting of unauthorized releases Ml <br /> 23 CCR 2715 Desi nated Operator: a Statement from UST owner; - Monthly inspection; Employee trainingt/ <br /> 24 CCR 2638 a Annual monitoring certification <br /> 25 CCR 2638(a) Annual line leak detector test Ml <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636 4 Annual line tightness test Ml <br /> 28 1 CCR 2661 Repair for tank/pipinE has had tightness test M2 <br /> 29 CCR 2643(e) Biennial tightness test of gravity pipingre-Jana 1, 1984 <br /> 30 CCR 2643 d Triennial line test for conventional suction piping re-Jana 1, 1984 M1 <br /> 31 HSC 25292.5 Double walls stem located within 1000'of public well-ELD <br /> 32 CCR 2661 Permit to repair UST system <br /> 33 HSC 25286 a Permit to alter monitoring system <br /> 34 HSC 25298 Pemut 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 Illegal abandonment of UST s stem <br /> 38 Other: <br /> EHD INSPECTOR: PHONE: UIC <br /> Septic system: <br /> ❑Serves>_20 people/day <br /> RECEIV Y: TITLE: [I Receives other than sanitary waste <br /> Other disposal methods: <br /> ❑Dry wells/French Drains <br /> EHD 23-02 <br /> 1/3/07 <br />