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°PautN'` • SAN JOAQUIN COUNTY IS <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> .:g. 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br /> ,P.. Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> �GIFOtta <br /> UNDERGROUND STORAGE TANK UST PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> Gns ��� ,r �sy,� ,, K SII, 107 <br /> Facility <br /> �address: UST# 5 6' -7 <br /> ty , <br /> 2,cc Ytl.SL�JI0 j l'7 �eN"C , I'��A'lUl� •Product 01 6� �l <br /> Facility Contact: Title: Phone: <br /> .110 kw DIXOtV MPrN�t�R 7��1 P2S77 <br /> Monitoring Panel: Piping system: Overfill prevention: / <br /> TtAfty rA1L6**-C40 I LVPressurized ❑Suction ❑Gravity Alechanical ❑Audible/visual <br /> Inspection type: --// Violations: <br /> Routine LYMonitorin Certification 11Installation ❑Other: ❑Ml-RDetect ElM2-RPrev 0]M-3 Both <br /> VIOLATIONS) HSC=Califomia Health&Safety Code;CCR=California Code of Regulations V R <br /> # Code Section 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 Pro am Consolidated Forms on file with EHD(Facility and tank farm <br /> 4 HSC 25292.2 Certification of financial res2onsibility and CFO letter <br /> 5 CCR 2632 c)(2)(D) Monitoring&response plan is current and filed with the local agency <br /> 6 CCR 2712 i Monitoring&response plan is onsite <br /> 7 CCR 2712 Maintenance&monitoring records (Mi) <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 Ml <br /> I 1 CCR 2630(d) UST system monitoring equipment is properly located to detect a leak (MI) <br /> 12 HSC 25291 UST system monitoring equipment isoperational MZ <br /> 13 CCR 2636 (1) Continuous monitoring system for underground piping&UDC is present (MI) <br /> 14 CCR 2631 a Primary containment is product tight <br /> 15 HSC 25291 a)(2) Secondary containment for UST is tight <br /> 16 CCR 2636(c)(1) All releases in secondary pipingflow to a collection sum <br /> 17 HSC 25291 Line leak detector(s)are installed (Ml <br /> 18 CCR 2635 1 Spill container M2 " <br /> 19 CCR 2635 2 Overfill prevention system <br /> M2) <br /> 20 CCR 2636(a) Conventional suction piping shall have continuous monitoring&2°containment <br /> 21 HSC 25291 (e) Water in 20 containment analyzed&properly disposed of <br /> 22 CCR 2650 Recording/reporting of unauthorized releases Ml <br /> 23 CCR 2715 Designated Operator: a Statement from UST owner, !�-&Monthly inspection; Em to ee train ng <br /> 24 CCR 2638(a) Annual monitoring certification <br /> 25 CCR 2638(a) Annual line leak detector test (Mi) <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636 4 Annual line tightness test Ml <br /> 28 CCR 2661 Repair for tank/piping has had tightness test M2 <br /> 29 CCR 2643 (e) Biennial tightness test of gravity piping(pre-January 1, 1984) <br /> 30 CCR 2643 d Triennial line test for conventional suction pi2ing(pre-January1, 1984 Ml <br /> 31 HSC 25292.5 Double walls stem located within 1000'of public well-ELD <br /> 32 CCR 2661 Permit to repair UST system <br /> 33 HSC 25286 a Permit to alter monitorin system <br /> 34 HSC 25298 6 Permit to temporarily close UST system <br /> 35 HSC 25298(c) Permit to close UST system <br /> 36 HSC 25299 a 9 Disablin leak detection devices <br /> 37 HSC 25298 a) Ille al abandonment of UST system <br /> 38 Other: <br /> EHD INSPECTOR: PHONE: UIC <br /> 34�X9 septic system <br /> ,M NI P10^^ 11 Serves 220 people/day <br /> RECEIV TITLE: ❑Receives other than sanitary waste <br /> /} Other disposal methods <br /> `J%�r•"a L ❑D wells/French Dmins <br /> EHD 23-02 <br /> 1/3/07 <br />