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SAN JOAQUIN COUNTY <br /> VIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, California 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)468-3433 Web:www.siaov.org/ehd <br /> UNDERGROUND STORAGE TANK UST PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection <br /> a�� Date: <br /> V, Z p 000-a tl /�AV&4- ;I-110101 <br /> Facility address: UST# /1, ,. S 6 ' <br /> 15-3 IF �w' �� S I a� I Product "r T7 <br /> Facility Contact: Title: Phone: <br /> ( dirl <br /> 7rin�g7P�anel: Piping system: Overfill prevention: <br /> /(P 35V &pressurized D Suction D GravityD Mechanical lYAudible/visual <br /> Insf action type: <br /> ��// Violations: <br /> LA'Routine LYMonitorin Certification 0 Installation 0 Other: 0 Mt-RDelect 0 M2-RPrev 0 M-3 Both <br /> VIOLATION(S) HSC=California Health&Safety Code; CCR=California Code of Regulations V R <br /> # Code Section V=Violation; RV=Re eat Violation V <br /> 1 HSC 25284 Permit to operate <br /> 2 CCR 2637 Seconds containment test performed <br /> 3 CCR 2711 b & c Current Unified Program Consolidated Forms on file with EHD(Facilityand tank form <br /> 4 HSC 25292.2 Certification of financial responsibility and CFO letter <br /> 5 CCR 2632 b MonitoringProgram(Monitoring&Response Plan is current and approved b the local agency. <br /> 6 CCR 2712 i Monitoringplan is onsite. <br /> 7 CCR 2712 b Maintenance&monitoringrecords M1 <br /> 8 monitoring of suction piping re-Janua , 1, 1984 <br /> 9 stem iso Prated to or vent unauthorized release <br /> 10 onitorin s stem is resent M7 <br /> 11 stem monitoringa ui ment is ro erl located to detect a leak M1 <br /> 12 stem monitoringequipment iso erational M1 <br /> 13 ous monitorin s stem for und--------d i in & UDC is resent Mt <br /> 14 containment is roduct ti ht <br /> _T5-j"s containment for UST is ti ht <br /> 16 CCR 2636 c 1 All releases in seconds in 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 revention system 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 Recordin reporting of unauthorized releases M1 <br /> 23 CCR 2715 Designated Operator: a Statement from UST owner; a Monthly ins ection; Employee training <br /> 24 CCR 2638 a Annual monitorinn 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 tightness test of gravily 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 /> 32CC­R2 61 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 25296 c Permit to close UST system <br /> 36 HSC 25299 Disabling leak detection devices <br /> a 9 2 <br /> 37 HSC 25296 a Illegal abandonment of UST system <br /> 38 Other: <br /> 'EHD INSPECTOR: PHONE: UIC <br /> ,t1 /_ (— 3(! ?: Septic system: <br /> AJ ' —1 V 5 7 ElServes>_20 people/day <br /> RECEIVED BY: TITLE:. ❑Receives other than sanitary waste <br /> Other disposal methods: <br /> D Dry wells/French Drains <br /> EHD 23-02-002 REV 8/08 <br />