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r SAN JOAQUIN COUNTY <br /> ONVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3`d Floor, Stockton,CA 95202- 08 <br /> c4 Telephone: (209)468-3420 Fax:(209)468-3433 Web: www.sjRov.org-/ch <br /> UNDERGROUND STORAGE TANK UST PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> (.I(L0.n1'r unl Vkk. Z` el) <br /> Facility address: p UST# <br /> 2`k2o UPDtt I� l�ilE Y �� Product <br /> Facility Contact: Title: Phone: `6 <br /> POW Ar► M t ti"A-5 <br /> Monitoring Panel: 6 Piping system: erfill prevention: <br /> It..{�JAQ-LV U"<<� Pressurized ❑Suction ❑Gravity Mechanical ❑Audible/visual <br /> Inspection type: lations: <br /> Routine NMonitoringCertification 0Installation ❑Other: MI-RDetect ❑M2-RPmv ❑M-3 Both <br /> # Code Section <br /> VIOLATIONS) HSC=Califomia Health&Safety Code;CCR=Califomia Code of Regulations V R 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 HHD(Facility and tank form <br /> 4 HSC 25292.2 Certification of financial responsibilitypand 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 pplan is onsite - <br /> 7 CCR 2712(b) Maintenance&monitoring records M] <br /> 8 CCR 2643(d) Daily in nitoring of suction piping(pre-January, 1, 1984 <br /> 9 HSC 25292.1 UST s stem isoperated to prevent unauthorized release <br /> 10 CCR 2632(c)(2 UST monitoring system is present (M/) <br /> 11 CCR 2630 d UST system monitoring equipment is properly located to detect a leak M] <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 sum <br /> 17 HSC 25291 ( Line leak detectors are installed M] <br /> 18 CCR2635 (b)(1) Sill container (M2 <br /> 19 CCR 2635 (b)(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 20 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; (c-e)Monthly inspection;(f)Employee training <br /> 24 CCR 2638 a Annual monitoring certification '4 <br /> 25 CCR 2638(a) Annual line leak detector test (M 1) <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 pipingre-Jana 1, 19 4) <br /> 30 CCR 2643 (d) Triennial line test for conventional suctionpipingpre-Jana 1, 1984) (Nil) <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 Permit 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 system <br /> 38 Other: <br /> END INSPECTOR: PHONE: l.i IC <br /> WtLOj OCA 2�—Lt 6;C-2J((� $ septic System: <br /> Serves 220 people/day <br /> RECEIVED BY: TITLE: Receives other than sanitary waste <br /> Other disposal methods: <br /> I I Dry wells/French Drains <br /> END 23-02-002 <br />