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SAN JOAQUIN COUNTY <br /> MVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, California 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 468-3433 Web:www siaov.orglehd <br /> UNDERGROUND STORAGE TANK UST PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection <br /> tt pry- <br /> Date: <br /> + <br /> 1­/ —Orr <br /> Facility address: UST# S /� <br /> Product F U r�•.� <br /> Facility Contact: Title: Phone: <br /> 1G�,�. L.Jr�fk•-3 (:D/51, L� <br /> onitoring Panel: Piping system: Overfill prevention: <br /> ,,, ressurized U Suction ❑Gravity echanical D Audible/visual <br /> Inspection type: Violations: <br /> Routine r onitorinCertification D Installation ❑Other. ❑M1-RDetect C M2-RPrev C M-3 Both <br /> VIOLATIONS} HSC=California Health &Safety Code; CCR=California Code of Regulations V R <br /> # Code Section V <br /> V=Violation; RV=Re eat Violation <br /> 1 HSC 25284 Permit tooperate <br /> 2 CCR 2637 Secondary containment test erformed <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 plan is onsite. <br /> 7 CCR 2712 b Maintenance & monitoring records M1 <br /> 8 CCR 2643 d Daily monitoring of suction piping (pre-Janua , 1, 1984 <br /> 9 HSC 25292.1 UST system isoperated to prevent unauthorized release <br /> 10 CCR 2632(c)(2L UST monitoring system is present (MI) <br /> 11 CCR 2630 d UST s stem 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 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 sump <br /> 17 HSC 25291 Line leak detectors are installed M1 <br /> 18 CCR 2635 (b)(1) Spill container (111112) <br /> 19 CCR 2635 'b 2 Overfill prevention system M2 <br /> 20 CCR 2636 (a) Conventional suction piping shall have continuous monitoring & 2°containment <br /> 21 HSC 25291 (e) Water in 2=containment analyzed & properly disposed of <br /> 22 CCR 2650 Recording/reporting of unauthorized releases M1 <br /> 23 CCR 2715 Designated Operator: a Statement from UST owner, (c-e) Monthly inspection; f) Employee trainin <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 testis <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 gravity piping (pre-January 1, 1984 <br /> 30 CCR 2643 d Triennial line test for conventional suction piping (pre-January 1, 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 Ille al abandonment of UST system <br /> 38 1 Other: <br /> EHD INSPECTO PHONE:L/ UIC <br /> �,.-, Septic system_ <br /> /a&d- ( 6S Serves>_20 people/day <br /> R�CEtVED Y TITLE: 1 Receives other than sanitary waste <br /> Other disposal methods' <br /> Dry weils/French trains <br /> EK0 23-02-002 REV 8108 <br />