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EHD 23-02-002 REV 8108 <br />SAN JOAQUIN COUNTY <br />4ONVIRONMENTAL <br />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 <br />REPORT <br />Facility name: <br />Designated Operator: <br />Inspection <br />DaT:001 <br />Facility address: <br />DST <br />Product <br />7.. <br />p <br />Vpx <br />Facility Contact: <br />Title: Phone: <br />L <br />% rvILQ, K,W\A -- 321 <br />,1,3 <br />: <br />nitye�: <br />Piping system: <br />Overfill prevention: <br />L <br />fInspiection <br />Gy <br />Pressurized ❑ Suction ❑ Gravit <br />echanical Audiblelvisualft Uc <br />Violations: <br />Routine <br />onitoring Certification ❑ Installation ❑ Other: <br />❑ M1-RDetect ❑ M2-RPrev ❑ M-3 Both <br />VIOLATIONS) HSC=California Health & Safety Code; CCR=California Code of Regulations V R <br /># <br />Code Section <br />V <br />V=Violation; RV=Re eat Violation <br />1 <br />HSC 25284 <br />Permit tooperate <br />2 <br />CCR 2637 <br />Secondary containment test performed <br />3 <br />CCR 2711 b & c <br />Current Unified Program Consolidated Forms on file with EHD Facility and tank form <br />4 <br />HSC 25292.2 <br />Certification of financial responsibility and CFO letter <br />5 <br />CCR 2632 b <br />Monitoring Program(Monitoring & Response Plan is current and approved by the local agency. <br />6 <br />CCR 2712 i <br />Monitorinq 21an is onsite. <br />7 <br />CCR 2712 b <br />Maintenance & monitoringrecords M1 <br />8 <br />CCR 2643 d <br />Daily monitoring of suction piping (pre-January, 1, 1984 <br />9 <br />HSC 25292.1 <br />UST system isoperated to prevent unauthorized release <br />10 <br />CCR 2632 c 2 <br />UST monitoringsystem is present M1 <br />11 <br />CCR 2630 d <br />UST system monitorin a ui ment is Rroperly located to detect a leak Will <br />12 <br />HSC 25291 b <br />UST system monitoring equipment isoperational M1 <br />13 <br />CCR 2636 '1 <br />Continuous monitoring s stem for underground piping & UDC is present M1 <br />14 <br />CCR 2631 a <br />Primary containment is product tight <br />15 <br />HSG 25291 (a)(2) <br />Secondary containment for UST is tight <br />16 <br />CCR 2636 (c)(1) <br />All releases in secondary pipingflow to a collection sum <br />17 <br />HSC 25291 <br />Line leak detectors are installed M1 <br />18 <br />CCR 2635 (b)(1) <br />Spill container {M2J <br />19 <br />CCR 2635 (b)(2) <br />Overfill prevention system M2 <br />20 <br />CCR 2636 (a) <br />Conventional suction piping shall have continuous monitoring & 20 containment <br />21 <br />HSC 25291 (e) <br />Water in 2° containment analyzed & pro erly disposed of <br />22 <br />CCR 2650 <br />Recording/reporting of unauthorized releases Mi <br />23 <br />CCR 2715 <br />Designated Operator: a Statement from UST owner;c-e Month!y inspe m to ee trainin <br />24 <br />CCR 263$ a <br />Annual monitoring certification <br />25 <br />CCR 263$ a <br />Annual line leak detector test M1 <br />26 <br />HSC 25284.2 <br />Annuals ill containment testing <br />27 <br />CCR 2636 4 <br />Annual line tightness test M1 <br />28 <br />CCR 2661 <br />Repair for tank/pipinghas had tightness test {M2) <br />29 <br />CCR 2643 a <br />Biennial tightness test of gravity pipinLere-January1, 1984 <br />30 <br />CCR 2643 d <br />Triennial line test for conventional suction pi in (re-January 1, 1984) (M1) <br />31 <br />HSC 25292.5 <br />Double walls stem located within 1000' of public well-ELD <br />32 <br />CCR 2661 <br />Permit to repair UST system <br />33 <br />HSC 25286 a <br />Permit to alter monitoring system <br />34 <br />HSC 25298 b <br />Permit to tem orarily close UST system <br />35 <br />HSC 25298 c <br />Permit to close UST system <br />36 <br />HSC 25299 <br />Disabling leak detection devices <br />a 9 2 <br />37 <br />HSC 25298 a <br />Ille al abandonment of UST system <br />38 <br />Other: <br />PHONE: <br />DIC <br />EHD INSPECTOR: ✓!l1 "' <br />lN'`1 <br />r ` f <br />2 "tel t?/� [� <br />S e s stem: <br />es >20 peoplelday <br />ECEIV7 <br />fT.L E: <br />✓i a� /y/ fn�S !� <br />- Recei other than sanitary waste <br />Other dis osa thods: <br />Dry wells/Frena ains <br />EHD 23-02-002 REV 8108 <br />