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ft SAN JOAQUIN COUNTY <br /> IW.NVIRONMENTAL HEALTH DEPARTMENT <br /> 304 Eas Weber Avenue, 3 d Floor, Stockton, CA 9520 /08 <br /> Telephone: (209)468-3420 Fax: (209)468-3433 Web:www.sjgov.or /g ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> lr>:�u—4[—b� <br /> Facility address: UST# t 3 <br /> Product ✓ 7M &15 Et <br /> Facility Contact: Title: Phone: <br /> `t <br /> �>�► 1 r��s c� Gw iJ6 3 3�1-3 cam 91 <br /> Monitoring Panel: Piping system: Overfill prevention: <br /> LS —vim Pressurized ❑Suction ❑Gravity ❑Mechanical Audible/visual <br /> Inspection type: Violations: <br /> Routine Monitoring Certification ❑Installation ❑Other: ❑Ml-RDetect ❑M2-RPrev ❑M-3 Both <br /> # Code Section <br /> VIOLATION(S) HSC=California Health&Safety Code;CCR=California 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 EHD(Facility and tank form) <br /> 4 HSC 25292.2 Certification of financial responsibility and CFO letter <br /> 5 CCR 2632(c)(2)(D) Monitoring&res onse plan is current and filed with the local agency <br /> 6 CCR 2712(i) Monitoring&response plan is onsite <br /> 7 CCR 2712(b) Maintenance&monitoring records M1 <br /> 8 CCR 2643(d) Daily monitoring of suction piping(pre-January, 1, 1984) <br /> 9 HSC 25292.1 UST system isoperated to prevent unauthorized release <br /> 10 CCR 2632 c)(2) UST monitoring system is present (MI) <br /> 1 1 CCR 2630(d) UST system monitoring equipment is properly located to detect a leak (M1) <br /> 12 HSC 25291 (b) UST system monitoring equipment isoperational M2) <br /> 13 CCR 2636(f)(1) Continuous monitoring system for underground piping&UDC is present (MI) <br /> 14 CCR 2631 a) Primary containment is product tight <br /> J 5 HSC 25291 (a)(2) Secondary containment for UST is tight <br /> 16 CCR 2636(c)(1) All releases in secondary piping flow to a collection sum <br /> 17 HSC 25291 (f) Line leak detector(s)are installed (MI) <br /> 18 CCR 2635 (b)(1) Spill container (M2) <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 training <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 testing <br /> 27 CCR 2636(f)(4) Annual line tightness test (MI) <br /> 28 CCR 2661 (f) Repair for tank/piping has had tightness test (M2) <br /> 29 CCR 2643 (e) Biennial tightness test of gravity piping( re-Januar 1, 1984) <br /> 30 CCR 2643 (d) Triennial line test for conventional suction piping( re-Jams 1, 1984) (MI) <br /> 31 HSC 25292.5 Double walls stem located within 1000'of ublic 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 1 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 /> EHD INSPECTOR: PHONE: UIC <br /> 2- , - `t b F, Septic system: <br /> Serves>_20 people/day <br /> RECEIVED BY: TITLE: Receives other than sanitary waste <br /> Other disposal methods: <br /> Dry wells/French Drains <br /> t�or)�-I ANY FAIT �'�P ►n©t')kTut>'A 1 P�-l.6p-t- `Ti�T is tz1EPAtKeD tyz- <br /> FHD23-02-002 ,���� 1v1 oy 1 �6 G lPE A PEQN� l'� e��f� i is Z�FF I r;L <br />