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SAN JOAQUIN COUNTY DATE `�/17/a°/ <br />PR# <br />IRONMENTAL HEALTH DEPARTMT PAGE <br />E. Weber Ave., Third Floor, Stockton, CA, , ,x:02 <br />(209) 468-3420 <br />UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br />Facility Name <br />acility Address Wo <br />Facilty Contact C—rvl 1e- (,- Title OGJruN Phone # <br />UST#_� Product UL UST#Product qZ UST# .? Product Ples.ai UST# ! Product <br />Overfill Prevention: ❑ AudibleNisual El echanical Monitoring Panel: 6 I [ �i,64 L <br />Piping System: ❑ Gravity p-PI'essure ❑ Suction ; Violations: ❑ M1-RDet ❑ M2-Rprev ❑ M3 -Both <br />Automatic Pump Shut Down Satisfies CCR 2636 (f)(5): M-Ye's 17 No Designated Operator: <br />INSPECTION TYPE: DRoutinet []Monitoring Certification ❑Complaint ❑Install ❑Removal ❑Repair/Upgrade <br />COMPANY NAME: <br />TECHNICIAN NAME: <br />VIOLATION(S) <br />PHONE:, 666 — y( <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 <br />HSC 25284 <br />Permit to operate <br />2 <br />CCR 2637 <br />Secondary cont. testing <br />3 <br />CCR 2711(b) & (c) Current State Forms A & B <br />. 4 <br />HSC 25292.2 <br />Certification of financial <br />Biennial tightness test of gravit) <br />responsibility & CFO letter <br />5 <br />CCR 2632 (c)(2) <br />UST monitoring is present (M1) <br />6 <br />CCR 2630 (d) <br />UST system monitoring <br />28 HSC 25286 (a) <br />Permit to alter monitoring <br />equipment is properly located to <br />system <br />29 HSC 25298 (a) <br />detect a leak (M1) <br />7 <br />HSC 25291 (b) <br />UST system monitoring <br />Permit to temporarily close USI <br />equipment is operational (M1) <br />8 <br />CCR 2636 (f)(1) <br />Continuous monitoring system <br />UST system is operated to <br />for underground piping & UDC <br />33 CCR 2650 <br />Record inglreporting <br />is present (M1) <br />9 <br />CCR 2636 (c)(1) <br />All releases in secondary piping <br />properly disposed of <br />flow to a collection sump <br />10 <br />HSC 25291 (f) <br />Line leak detector(s) (M1) <br />11 <br />HSC 25291(a)(2) <br />Secondary containment for <br />37 HSC 25299(x)(9) <br />Disabling leak detect. Devices <br />UST is tight <br />12 <br />CCR 2635 (b)(1) <br />Spill container (M2) <br />13 <br />HSC 25284.2 <br />Annual spill container testing <br />14 <br />CCR 2635 (b)(2) <br />Overfill prevention system (M2) <br />15 <br />CCR 2631 (a) <br />Primary containment is product - <br />tight <br />. 16 <br />CCR 2632 (c) (2)(D)Monitoring & response plan <br />17 <br />CCR 2712 (i) <br />Monitoring & response plan is <br />on site <br />18_ZCCR <br />2712 (b) <br />Maintenance & monitoring <br />' records (M1) <br />19 <br />CCR 2636 (f)(4) <br />Annual line tightness test <br />20 <br />CCR 2638 (a) <br />Annual line leak detector test <br />(M1) <br />21 <br />CCR 2638 (a) <br />Annual monitoring certification <br />22 <br />CCR 2661 (f) <br />Repair for tank/piping has had <br />tightness test M2 <br />EHD INSPECTOR: <br />RECEIVED BY: <br />/ <br />23 CCR 2643 (d) <br />Daily monitoring of suction <br />piping (pre -111184) <br />24 CCR 2636 (a) <br />Conventional suction piping <br />shall have continuous <br />monitoring & 20 containment <br />25 CCR 2643 (e) <br />Biennial tightness test of gravit) <br />piping (pre -111184) <br />26 CCR 2643 (d) <br />Triennial line test for <br />conventional suction (pre - <br />27 ✓ CCR 2661 <br />1/11/84) (M1) <br />Permit to repair UST system <br />28 HSC 25286 (a) <br />Permit to alter monitoring <br />system <br />29 HSC 25298 (a) <br />III'egal abandonment of UST <br />system <br />30 HSC 25298 (b) <br />Permit to temporarily close USI <br />system <br />31 HSC 25298 (c) <br />Permit to close UST system <br />32 HSC 25292.1 <br />UST system is operated to <br />prevent unauthorized release <br />33 CCR 2650 <br />Record inglreporting <br />unauthorized release (M1) <br />34 HSC 25291 (e). <br />Water in 20 cont analyzed and <br />properly disposed of <br />35 CCR 2640 (e) <br />Single wall component within <br />1 000'of Public Well, no ELD <br />36 CCR 2635(a)(2)(A) Cathodic protection testing & <br />60 day inspection log (M2) <br />37 HSC 25299(x)(9) <br />Disabling leak detect. Devices <br />38 CCR 2715(a) <br />Statement from UST owner <br />39 CCR 2715(c) <br />Monthly inspection by D.O, <br />40 CCR 2715 (f) <br />D.O. trained employees <br />41 <br />Violation(s) not listed above <br />PHONE: <br />TITLE: <br />Septic System: ❑ Serves 2 20 persons/day ❑ Receives other than sanitary waste <br />Other Disposal Units Identified: ❑ Dry wells/French Drains <br />C:YOOCUME-1l jacksonSLOCALS-11TemplUST inspection9.15.04.DOC <br />