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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.sigoy.orq/ehd <br />UNDERGROUND STORAGE TANK (USTI PROGRAM INSPECTION REPO <br />Facility name: <br />T6 <br />Facility address: <br />"" I�"� � � LOfJ <br />Facility Contact: Title: Phone: <br />�h S <br />M itori ��anet: Piping system: <br />,, ressurized 0 Suction 0 Gravityecha <br />Inspection type: <br />outine JOAonitoring Certification 0 Installation 0 Other: <br />Designated Operator:RT Inspection <br />Date: nq <br />� <br />usT # <br />�'�roduct � Got Sd�l '9 <br />Overfill prevention: <br />iolnical 0 Audible/visual <br />Vations: <br />X M1-RDetect 0 M2-RPrev 0 M-3 Both <br /># <br />Code Section <br />VIOLATION(S) HSC=Califomia Health & Safety Code; CCR=California Code of Regulations V R <br />V=Violation; RV=Re eat Violation V <br />1 <br />HSC 25284 <br />Permit too este <br />2 <br />CCR 2637 <br />Secondary containment test performed 1_ - <br />AA <br />3 <br />CCR 2711 b & c <br />Current Unified Pro ram Consolidated Forms on file with EHD Facilit and tank form <br />4 <br />, HSC 25292.2 <br />Certification of financial responsibility and CFO letter <br />5 <br />, CCR 2632 b <br />MonitoringProgram (Monitoring& Response Plan is current and approved b the local a enc . <br />6 <br />7 <br />CCR 2712 i <br />CCR 2712 b <br />Monitoring Ian is onsite. <br />Maintenance & monitoring records t <br />M1 <br />8 <br />CCR 2643 d <br />Daily monitorina of suction piping (pre -January, 1, 1984 <br />9 <br />HSC 25292.1 <br />UST system is operated to prevent unauthorized release <br />10 <br />CCR 2632 (c)(2) <br />UST monitoring system is present <br />M1 <br />11 <br />CCR 2630 d <br />UST system monitoring equipment is properly located to detect a leak M1 <br />12 <br />HSC 25291 b <br />UST sVstemT monitoring equipment isoperational <br />M1) <br />13 <br />CCR 2636 1 <br />Continuous monitoring system for underground piping & UDC <br />is present M1 <br />14 <br />CCR 2631 a <br />Primary containment is product tight <br />15 <br />HSC 25291 (a)(2) <br />Secondary containment for UST is tight <br />16 <br />CCR 2636 (c)(1) <br />All releases in secondary pipingflow to a collection sum <br />17 <br />HSC 25291 <br />Line leak detectors are installed <br />N11 <br />18 <br />CCR 2635 (b)(1) <br />Spill container <br />N12) <br />19 <br />CCR 2635 (b)(2) <br />Overfill prevention system <br />M2 <br />20 <br />CCR 2636 (a) <br />Conventional suction piping shall have continuous monitoring <br />& 20 containment <br />21 <br />HSC 25291 (e) <br />Water in 20 containment analyzed & properly disposed of <br />CCR 2650 <br />Recordingreporting of unauthorized releases <br />M1 <br />10. <br />CCR 2715 <br />Designated Operator: a Statement from UST owner; c- <br />Monthly inspection; Employee training <br />CCR 2638 a <br />Annual monitoring certification e, <br />25 <br />CCR 2638 a <br />Annual line leak detector test <br />M1 <br />26 <br />HSC 25284.2 <br />Annuals ill containment testin <br />d -II -/S <br />27 <br />CCR 2636 4 <br />Annual line tightness test <br />M1 <br />28 <br />CCR 2661 <br />Repair for tank/piping has had tightness test <br />M2 <br />29 <br />CCR 2643 a <br />Biennial tightness test of gravity piping(pre-January 1, 1984 <br />30 <br />CCR 2643 d <br />Triennial line test for conventional suction piping (pre-January1, <br />1984) Mt <br />31 <br />HSC 25292.5 <br />Double walls stem located within 1000' of public well-ELD <br />32 <br />CCR 2661 <br />Permit to repair UST system <br />33 <br />HSC 25286 a <br />Permit to alter monitoring system <br />34 <br />HSC 25298 b <br />Permit to mporarily close UST system <br />35 <br />HSC 25298 c <br />Permit to close UST system <br />36 <br />HSC 25299 <br />a e 2 <br />Disabling leak detection devices <br />37 <br />HSC 25298 a <br />Illegal abandonment of UST system <br />38 <br />Other: <br /># <br />EHD IN P CTO <br />PRONE: <br />`fl,/t�A <br />UIC � <br />Septic system: <br />❑ Serves >_20 people/day <br />D Receives other than sanitary waste <br />Other disposal methods: <br />❑ Dry wells/French Drains <br />RECEIVED BY: <br />TITLE:. <br />EHD 23-02-002 REV 8108 <br />