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SAN JOAQUIN COUNTY <br /> .NVIRONMENTAL HEALTH DEPARTMENT <br /> 600 hast 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: Designated Operator: Inspection <br /> 6>T&f?_7 Ex)w-z blv6 Date: <br /> 4A Q)WI <br /> Facility address: UST# - Z <br /> 71o(I <br /> AIM" w!� ow1� ' 'Product '"L g <br /> Facility Contact: Title: Phone: <br /> Monitoring Panel: Piping system: Overfill prevention: <br /> V/Z- 6(pressurized D Suction D Gravity ❑Mechanical ❑Audible/visual <br /> Inspection type: Violations: <br /> Routine V Monitoring Certification D Installation ❑Other: D Mt-RDetect D M2-RPrev D M-3 Both <br /> # Code Section <br /> VIOLATION(S) HSC=Califomia Health&Safety Code;CCR=California Code of Regulations V R <br /> V=Violation;RV=Re eat Violation V <br /> 1 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 b Monitoring Program(Monitoring&Response Plan is current and approved by the local agency. <br /> 6 CCR 2712 i Monitoring Ian is onsite. <br /> 7 CCR 2712 b Maintenance&monitoring records M1 <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 (M1) <br /> 11 CCR 2630 d UST system monitoring equipment is properly located to detect a leak M1 <br /> 12 HSC 25291 b UST system monitoring equipment isoperational (M1) <br /> 13 CCR 2636 1 Continuous monitoring system for underground piping&UDC is present M1 <br /> 14 CCR 2631 a Primary containment is product fight <br /> 15 1 HSC 25291 (a)(2) Secondary containment for UST is tight <br /> 16CCR 2636 c 1 All rele; ig flow to a collection sum <br /> 17 HSC 25291 Line leak detectors are installed M1 <br /> 18 CCR 2635(b)(1) Spill container M2 <br /> 19 CCR 2635(b)(2) Overfill prevention s stem M2 <br /> 20 CCR 2636(a) Conventional suction piping shall have continuous monitoring&20 containment <br /> 21 HSC 25291 (e) Water in 20 containment analyzed&properly disposed of <br /> 22 CCR 2650 Recording/reporting of unauthorized releases M1 <br /> 23 CCR 2715 Designated Operator: t9bStatement from UST owner; (c-e)Monthly inspection; Employee training <br /> 24 CCR 2638 a Annual monitoring certification <br /> 25 CCR 2638 a Annual line leak detector test M1 <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636 4 Annual line tightness test M1 <br /> 28 CCR 2661 Repair for tank/piping has had tightness test (M2 <br /> 29 CCR 2643 a Biennial tihtness test of gravity piping (pre-January 1, 1984 <br /> 30 CCR 2643 d Triennial line test for conventional suction piping(pre-January1, 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 b Permit to temporarily close UST system <br /> 35 HSC 25298 c Permit to close UST system <br /> 36 HSC 25299 Disabling leak detection devices <br /> a 9 2 <br /> 37 HSC 25298 a Illegal abandonment of UST system <br /> 38 Other. <br /> EHD INSPE TOR: / PHONE: UIC <br /> 'y_V/ 3 3 Seo6c system: <br /> ❑Serves 220 people/day <br /> RECEIVED TITLE- ❑Receives other than sanitary vraste <br /> Other disposal methods <br /> D Dry mils/French Drains <br /> EHD 23-02-002 REV 8/08 <br />