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0 U I <br /> ��.•. �•.fl� � SAN JOAQUINCOUNTY <br /> 4' a< ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> Iiij-7 <br /> Telephone:(249)468-3420 Fax: (209)464-0138 Web: www.sjgov.arglehd <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: inspection Date: <br /> UST 0 <br /> Facilitt� Iddress: <br /> Pradact <br /> Facility Contact: ♦ Title: Phone: , <br /> Monitoring Panel: Piping system: — ----- Overfill prevention: <br /> ressurized F�'Suction ©Gravity Mechanical ❑Audible/visual <br /> Inspection type: Violations: <br /> outine onitoring Certilication C Installation 11 Other: �7 Ml-RDetect M2-RPrevM"3 f3nR <br /> VIOI,ATION(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 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 601, <br /> 5 CCR 2632(c)(2)(D) Monitoring&response plan is current and filed with the local agency <br /> 6 CCR 2712(i)- Monitoring&res onse plan is onsite w <br /> 7 CCR 2712 b) Maintenance&monitoring records (M1) <br /> $ CCR 2643 d) Daily monitoring of suction piping(pre-Januar , 1, 1984) <br /> 9 HSC 25292.1 UST system is operated to prevent unauthorized release <br /> 10 CCR 2632(c)(2) UST monitoringsystem is resent M1 <br /> 11 CCR 2630(d) UST system monitoringequipment is property located to detect a leak MI) <br /> 12 HSC 25291 b UST system monitoringequipment isoperational <br /> (M2 <br /> 13 CCR 2636(f)(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)(1) All releases in secondary 2ipingflow to a collection sum <br /> 17 HSC 25291 (f) bine leak detector(s)are installed (M1) <br /> 18 CCR 2635 1 Spill container ='a <br /> 19 CCR 2635 (b)(2) Overfill prevention system <br /> 20 CCR 2636(a) Conventional suction i in shall have continuous monitoring&2°containment <br /> 21 HSC 25291 (e) Water in 2°containment analyzed&properly disposed of <br /> 22 CCR 2650 Recordin re artin of unauthorized releases <br /> 23 CCR 2715 Desi nated O erator (a Statement from UST owner; (c-e)Monthl ins ection; f)E <br /> 24 CCR 2638(a) Annual monitoriniz cerfification <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 (M1) <br /> 28 CCR 2661 f) Repair for tank/piping has had tightness test M2) <br /> 29 CCR 2643 (e) Biennial tightness test of gravity piping( re-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 /> 33MOther: <br /> a) Permit to alter monitoringsystem <br /> 34b Permit to temporarily close UST s stem <br /> 35 (c) Permit to close UST system <br /> 36a 9 Disablingleak detection devices <br /> 37 (a) Ille al abandonment of UST system <br /> 38 <br /> EHD INSPE R: PHONE: UIC <br /> 1, { l }(] lJ t� Septic Serves <br /> � ',Serves?20 people/day <br /> Eh L <br /> RECEIVED BY- 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 />