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T DATE � �� � <br /> SAN JOAQUIN COUNTY <br /> IIRONMENTAL HEALTH DEPARTMtNT PAGE y Off_ <br /> 304 E.Weber Ave., Third Floor, Stockton, CA 95202 <br /> (209)468-3420 <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility Name Facility Address \_N\oo <br /> w per- -Ce \ <br /> Facilty Contact Wwar-_ Title Phone# <br /> UST#_)�_= Produc&\UF-\. UST# Product UST# Product UST# Product <br /> Overfill Prevention: ❑AudibleNisual C+3/Mechyfiical ' 'F Monitoring Panel: v — D <br /> Piping System: ❑Gravity ❑ Pressure g'Suction / Violations: Minor ❑ ajor <br /> Automatic Pum Shut D wn Sati ies CCR 2638(g): ❑Yes C�No Dispenser Pan: ❑Yes No <br /> INSPECTION TYPE: &Aoutine rfMonitoring Certification ❑Complaint ❑install ❑Removal ❑Repair/Upgrade <br /> COMPANY NAME: ~,OW TECHNICIAN NAME: PHONE: <br /> VIOLATION(S) <br /> The above facility is not in compliance with the following section(s) of Health & Safety Code (HSC) and/or <br /> California Code of Regulations (CCR): <br /> 1 HSC 25284 Permit to operate 20 CCR 2712 (b) Maintenance & monitoring <br /> 2 CCR 2637 Secondary cont testing (6 records <br /> month/36 month) 21 CCR 2636 (f)(4) Annual line tightness test <br /> d <br /> 3 CCR 2711(b)& (c) Current State Forms A&B 22 CCR 2630 (d) Annual line leak detector test <br /> 4::y HSC 25292.2 Certification of financial 23 CCR 2630 (d) Annual monitoring certification <br /> responsibility and letter from 24 CCR 2643 (d) Daily monitoring of suction <br /> chief financial officer piping that is not continuously <br /> 5 CCR 2630 (d) Continuous monitoring system monitored <br /> for UST system 25 CCR 2643 (d) Triennial tightness test of <br /> 6 CCR 2636 (c)(1) All releases in secondary piping suction piping that is not <br /> continuously monitored <br /> flow to a collection sump <br /> 26 CCR 2643 (e) Biennial tightness test of gravity <br /> 7 HSC 25291 {e) Water in secondary(2°)cont piping that is not continuously <br /> 8 HSC 25291 (f) Automatic line leak detector(s) monitored <br /> 9 CCR 2636 (f)(1) Continuous monitoring system requirements for UST <br /> for underground piping 27 CCR 2662 Upgradere q <br /> 10 CCR 2632 (c)(2) Continuous monitoring system <br /> system <br /> for UST 28 CCR 2661 Permit to repair UST system <br /> Permit to alter monitoring <br /> (a) <br /> 11 HSC 25291(a)(2) Secondary containment for 29 HSC 2system <br /> UST is tight <br /> 12 CCR 2636 (f)(1) Continuous monitoring system 30 HSC 25298 (a) Illegal abandonment of UST <br /> for dispenser system system <br /> 13 CCR 2635(b)(1) Spill container 31 HSC 25298 (b) Permit to temporarily close UST <br /> 14 CCR 2635(b)(2) Overfill prevention system <br /> system <br /> 15 CCR 2631 (a) Primary containment is product- <br /> 32 HSC 25298 (c) Permit to dose UST system <br /> tight 33 HSC 25291 (e) Water in 20 cont analyzed and <br /> properly disposed of <br /> 16 HSC 25292.1 UST system is operated to Single wall component within <br /> prevent unauthorized release 34 CCR 2640 {e) 1000,of Public Well, no ELD <br /> 17 CCR 2650 Recording/reporting <br /> unauthorized release 35 CCR 2635(a)(2)(A)Cathodic protection testing <br /> 18 CR 2632 (d) Monitoring &response plan 36 H&SC 25299(a)(9)Disabling leak detect. devices <br /> 19 CCR 2712 (i) Monitoring &response plan is 37 <br /> Violation(s) not listed above <br /> on site <br /> EHD INSPECTO PHONE: Vt� -3wlrOal <br /> RECEIVED BY: TLE: � io,•1 MR»/ - - HONE: o�O9--58'�—��eoo <br /> 1 <br /> UNffOVUSTIINSP(rev 315102) f <br />