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DATE— <br /> I Z O <br /> PR# o <br /> PAGE I of OL — <br /> PUBLIC HEALTH SERVICES SAN JOAQUIN COUNTY ('p4.1- 3is <br /> ENVIRONMENTAL HEALTH DIVISION Hu-j <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 E✓1even '1321goR Facility Address :5 . <br /> Facilty Contact Fe9h Cr[ ( � Title CuJ no Phone # <br /> UST# Product (� Ut_ UST#�2 Product�y U —UST#_Prvouduct Q(�t_UST#_Product <br /> OVERFILL PREVENTION: U Au�ible/Visual Mechanical ori 6"Omonitoring P nel: \fecln. 12 c± 1 -.3 <br /> PIPING SYSTEM: ❑Gravity q'Pressure ❑Suction Violations: Minor ❑ Major <br /> AUTOMATIC PUMP SHUT DOWN SATISFIES CCR 2636 : VYes o No <br /> INSPECTION TYPE: VRoutine 191VIonitoring Certification oComplaint ❑Install ❑Removal ❑Repair/Upgrade <br /> COMPANY NAME. TECHNICIAN NAME: PHONE:( - -Z <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 /> 17 CCR 2650 Recording/reporting <br /> 1 HSC 25284 Permit to operate unauthorized release <br /> 2 CCR 2637 Secondary Cont.Testing 18 CCR 2632 (d) Monitoring & response plan <br /> 3:CCR 2711(b)& (c) Current State Forms A& B 19 CCR 2712 (i) Monitoring & response plan <br /> 4 HSC 25292.2 Certification of financial is on site <br /> responsibility and letter from 20__�/ CCR 2712 (b) Maintenance & monitoring <br /> chief financial officer records <br /> 5 CCR 2630 (d) Continuous monitoring 21 CCR 2636 (f)(4) Annual line tightness test l' <br /> system for UST system 22 CCR 2630 (d) Annual line leak detector test <br /> 6 CCR 2636 (c)(1) All releases in secondary 23—CCR 2630 (d) Annual monitoring <br /> piping flow to a collection certification <br /> sump 24 CCR 2643 (d) Daily monitoring of suction <br /> 7__�/_CCR 2636 (a) Secondary containment for piping that is not <br /> piping is waterproof continuously monitored <br /> 8 HSC 25291 (f) Automatic line leak 25—CCR 2643 (d) Triennial tightness test of <br /> detector(s) suction piping that is not <br /> 9 CCR 2636 (f)(1) Continuous monitoring continuously monitored <br /> system for underground 26—CCR 2643 (e) Biennial tightness test of <br /> ` piping gravity piping that is not <br /> 10 CCR 2632 (c)(2) Continuous monitoring continuously monitored <br /> system for UST 27 CCR 2662 Upgrade requirements for <br /> 11 HSC 25291(a)(2) Secondary containment for UST system <br /> UST is tight 28 CCR 2661 Permit to repair UST system <br /> 12 CCR 2636 (f)(1) Continuous monitoring 29_HSC 25286(a) Permit to alter monitoring <br /> system for dispenser system system <br /> 13 CCR 2635(b)(1) Spill container 30 HSC 25298 (a) Illegal abandonment of UST <br /> 14 CCR 2635(b)(2) Overfill prevention system system <br /> 15 CCR 2631 (a) Primary containment is 31_ HSC 25298 (b) Permit to temporarily close <br /> product-tight UST system <br /> 16 HSC 25292y <br /> .1 UST system isoperated to 32 HSC 25298 (c) Permit to close UST system <br /> prevent unauthorized release 33_ Violation(s)not listed above <br /> EHD INSPECTOR: <br /> RECEIVED BY: 1 TITLE: PHONE: <br />