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• SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, California 95202-3029 <br />Telephone: (209) 468-3420 Fax. (209) 468-3433 Web. www.s' ov.or ehd <br />UNDERGROUND STORAGE TANK <br />Facility name: <br />Sub 1) PROGRAM INSPECTION REPORT <br />1 <br />_//moo <br />t/ Designated Operator: Inspection Date: <br />(.�'/j <br />I�NI'w/1 !i <br />I' Q� <br />Facility addre <br />1 A I <br />UST # <br />S <br />1�j , <br />ProductTitle: <br />Phone: <br />VFacIflontac[: <br />P oel <br />Pim s stem: <br />pgy <br />Overfll prevention: <br />type: <br />Pressurized ❑ Suction ❑ Gravit echanical ❑ Audible/visual <br />Routine Monitorin <br />Violations: <br />Certification El Installation ❑Other; <br />I-RDetect ❑ M2-RPrev <br />❑ M-3 Both <br /># Code Section <br />VIOLATION(S) HSC=Califomia Health & Safety Code; CCR=California Code of Regulations <br />V R <br />I HSC 25284 <br />V=Violation; RV=R <br />Permit too erste :at Violation <br />V <br />2 CCR 2637 <br />Seconda containment test performed <br />3 CCR 2711 b) & c <br />Current Unified Pro m Consolidated Forms on file with EHD Facilit and tank form) <br />4 HSC 25292.2 <br />Certification of financial res onsib. and CFO letter <br />5 CCR 2632 6 <br />Monitorin Program (Monitoring &Response Plan) is curren6 t and a roved b the local a enc <br />CCR 2712 <br />. <br />nitorin Ian is <br />7 CCR2712 6 <br />Maintenance&monitorin records <br />8 CCR 2643 d <br />Ml <br />Dail monitorin ofsuction piping (pre -January, I, '9 14) <br />9 HSC 25292.1 <br />UST s stem isoperated to prevent unauthorized release <br />10 CCR 2632 c 2) <br />UST monitoring system is present <br />III CCR 2630 d <br />(Ml) <br />UST s stem monitorin a ui ment is ro eel located to detect a leak MI) <br />12 HSC 25291 6 <br />UST s stem monitorin a ui ment iso erational <br />13 CCR 2636 1 <br />(M2) <br />Continuous monitorin s stem for under round i in &UDC is resent <br />14 CCR 2631 a <br />MI <br />Prima containment is roduet ti ht <br />15 HSC 25291 a 2 <br />Second. containment for UST is ti ht <br />16 CCR 2636 c 1) <br />All rese'ary pipingflow to a collection sum <br />leaeak <br />17 HSC 25291 <br />Line ldetectors are installed <br />18 CCR 2635 6 1) <br />'T9.. <br />... <br />S ill container <br />CCR2635 b 2 <br />(M2) <br />Overfill reventions stem <br />20 CCR 2636 (a) <br />(M2 <br />Conventional suction i in shall have continuous monitoring& 20 containment <br />21 HSC 25291 (e) <br />Water in 20 containment analyzed & properly disposed of <br />22 CCR 2650 <br />Recordinr ortin o' authorized releases <br />23 CCR 2715 <br />MI) <br />Desi nated O erator a) tatement from UST own (c -e) $Ionthly inspection- t) Em to ce trainin <br />D CCR 2638 a <br />Annual monitorin ce rfication <br />25 CCR 2638 a) <br />Annual line leak detector test <br />26 HSC 25284.2 <br />(M 1) <br />Annuals ill containment testin <br />27 CCR 2636 4 <br />Annual line ti htness test <br />28 CCR 2661 <br />Ml) <br />R air for tank/pipinghas had tightness test <br />29 CCR 2643 a <br />(M2) <br />Biennial tightness test of gravitypipin re -Janus I, 1984 <br />30 CCR 2643 d) <br />ion <br />Triennial line test for convental suction i in re -Janus I, 1984) MI) <br />31 HSC 25292.5 <br />Double wall s stem located within 1000' of ublic well-ELD <br />32 CCR 2661 <br />Permit to re air UST s stem <br />33 HSC 25286 a <br />Permit to alter monitorin s stem <br />34 HSC 25298 b) <br />Permit to temontrily close UST system <br />35 HSC 25298 c <br />Permit to close USTs stem <br />36 HSC 25299 1a)(9) <br />Disablin leak detection devices <br />37 1 HSC 25298 a <br />Illegal abandonment of UST s stem <br />— <br />3F I Other: <br />E D INS CT <br />PHONE: <br />nI UIC <br />VII �/ Septic svemsvem <br />CEIVED Y: <br />_Serves >_20 people/day <br />iL <br />TITLE: — Receives other than sanitary waste <br />Other disilosal methods <br />wells/French Drains <br />V t . . <br />EHD 23-02-002 REV 05/07 <br />