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- SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3rd Floor, Stockton,CA 95202%708 <br /> Telephone.(209)468-3420 Fax:(209)468-3433 Web:www.sigov.org <br /> UNDERGROUND STORAGE TANK UST PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> lv,kC,-t v5p 5ee-v d'� cs� Joh wcx-oci <br /> Facility address: UST L1 # , <br /> 15 W L,isw�w 9—�/ <br /> Product '6 <br /> Facility Contact: Title: Phone: - <br /> JOA0 wcea-6MA pip'. 'or., rwt�eoa�a�norl <br /> Monitoring Panel: Pi ing system: Overfill prevention: <br /> r.IQrJ X7 b Pressurized ❑Suction ❑Gravity Mechanical ❑Audible/visual <br /> nspection type: Violations: <br /> Routine )(Monitoring Certification ❑Installation ❑Other: ❑MI-RDetect ❑M2-RPrev ❑M-3 Both <br /> VIOLATION(S) HSC=California Health&Safety Code;CCR=Califomia Code of Regulations V R <br /> # Code Section <br /> V=Violation;RV-Repeat Violation V <br /> 1 HSC 25284 Permit tooperate <br /> 2 CCR 2637 Secondary containment test performed <br /> 3 CCR 2711 6 & 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&response plan is current and filed with the local agency <br /> 6 CCR 2712(i) Monitoring&response plan is onsite <br /> 7 CCR 2712 6 Maintenance&monitoring records Ml <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 1 CCR 2632(c)(2) UST monitoring system is present (MI) <br /> I I CCR 2630 d UST system monitoring equipment is properly located to detect a leak Ml <br /> 12 HSC 25291 6 UST system monitoring equipment isoperational M2 <br /> 13 CCR 2636 1 Continuous monitoring system for under round piping&UDC is present (Ml) <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 piping Dow to a collection sum <br /> 17 HSC 25291 Line leak detector(s)are installed MI <br /> 18 CCR 2635(b)(1) Spill container (M2 <br /> 19 1 CCR 2635(b)(2) Overfill prevention system M2 <br /> 20 CCR 2636(a) Conventional suction piping shall have continuous monitoring&20 containment <br /> 21 HSC 25291 (e) Water in 20 containment analyzed&properly disposed of <br /> 22 CCR 2650 Recording/reporting of unauthorized releases M 1 <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 (Nil) <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 pipingre-Janus 1, 1984 <br /> 30 CCR 2643(d) Triennial line test for conventional suction piping(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 re air UST s stem <br /> 33 HSC 25286 a) Permit to alter monitoring system <br /> 34 HSC 25298 ) Permit to temporarily close UST system <br /> 35 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 /> END INSPECTOR: PHONE: UIC <br /> 6l6�i��(� Septic system: <br /> C Serves 220 people/day <br /> RECEIVED BY: TITLE: Receives other than sanitary waste <br /> Other disposal metlm& <br /> Ct�9N� —Dry wells/French Drains <br /> END 23-02-002 <br />