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" DATE 1212/oLl <br /> SAN JOAQUIN COUNTY PR# n2l 1 <br /> I1VIRONMENTAL HEALTH DEPARI&T PAGE <br /> 304 E.Weber Ave.,Third Floor, Stockton, CA 95202 <br /> (209)468-3420 <br /> UNDERGROUND STORAGE TANK(UST).PROGRAM INSPECTION REPORT <br /> Facility NameDlLfoL Facility Address k '7U N, M4 w 5f ' , <br /> Facilty Contacic eL A (Z (,'�Title lmo� Phone # PZ 3— ( 3 r'{� <br /> UST# S Product_ UST#Product G ( UST#_Prod uct UST#_Productt �� <br /> Overfill Prevention: )(Audible/Visual D Mechanical Monitoring Panel: (i1llp.4ILo 9A4'(-' <br /> Piping System: D Gravity Pressure D Suction Violations: D M1-RDet D M2-Rprev U M3-Both <br /> Automatic Pump Shut Down Satisfies CCR 2636 (f)(5): Yes D No Designated Operator: <br /> INSPECTION TYPE: t�outine)vlonitoring Certification ❑Complaint Dinstall ❑Removal ❑Repair/Upgrade <br /> COMPANY NAME:T-A V, NodI TECHNICIAN NAME: DD 4r PHONE: <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 /> 1 HSC 25284 Permit to operate 23—CCR 2643 (d) Daily monitoring of suction <br /> 2—CCR 2637 Secondary cont. testing piping (pre-1/1/84) <br /> 3 CCR 2711(b) & (c) Current State Forms A& B 24 CCR 2636 (a) Conventional suction piping <br /> 4 HSC 25292.2 Certification of financial shall have continuous <br /> responsibility& CFO letter monitoring &20 containment <br /> iennia <br /> 5—CCR 2632 (c)(2) UST monitoring is present (M1) 25 CCR 2643 (e) pip ng (l tightness <br /> test of gravit. <br /> 6—CCR 2630 (d) UST system monitoring <br /> equipment is properly located to 26 CCR 2643 (d) conventional test <br /> tsuctio r (pre- <br /> detect a leak(M1) 1!1/84) (M1) <br /> 7 CCR 2637(b) UST system monitoring <br /> equipment is operational (M1) 27 CCR 2661 Permit to repair UST system <br /> 8 CCR 2636 (f)(1) Continuous monitoring system 26—HSC 25286 (a) Permit to alter monitoring <br /> for underground piping & UDC system <br /> is present(M1) 29 HSC 25298 (a) Illegal abandonment of UST <br /> 9 CCR 2636 (c)(1) All releases in secondary piping system <br /> flow to a collection sump 30—HSC 25298 (b) Permit to temporarily close LIS- <br /> 10 HSC 25291 (f) Line leak detector(s)(M1) system <br /> 11_HSC 25291(a)(2) Secondary containment for 31_HSC 25298 32 HSC 25292.1c) Permit to cloe UST UST system is operated tt m <br /> UST is tight — <br /> 12 CCR 2635 (b)(1) Spill container(M2) prevent unauthorized release <br /> 13 HSC 25284.2 Annual spill container testing 33—CCR 2650 Recording/reporting <br /> 14 CCR 2635 (b)(2) Overfill prevention system (M2) unauthorized release (M1) <br /> 15 CCR 2631 (a) Primary containment is product 34—HSC 25291 (e) Water in 20 cont analyzed and <br /> tight properly disposed of <br /> 16 CCR 2632 (d) Monitoring &response plan 35 CCR 2640 (e) Single wall component within <br /> 17 CCR 2712 (i) Monitoring &response plan is 1000' of Public Well, no ELD <br /> on site 36—CCR 2635(a)(2)(A)Cathodic protection testing & <br /> 18 CCR 2712 (b) Maintenance & monitoring 60 day inspection log (M2) <br /> records(M1) 37—H&SC 25299(a)(9)Disabling leak detect. Devices <br /> 19—CCR 2636 (f)(4) Annual line tightness test 38_CCR 2715(a) Statement from UST owner <br /> 20 CCR 2630 (d) Annual line leak detector test 39 CCR ( <br /> 40—CCR 2715 (f) D.O Monthly <br /> (M1) trained employees <br /> 21 CCR 2630 (d) Annual monitoring certification 41— Violation(s) not listed above <br /> 22 CCR 2661 (f) Repair for tank/piping has had <br /> ti htness test M2 ut /� n <br /> EHD INSPECTO V h- PHONE: pF7 — "G D <br /> RECEIVED BY: TITLE: <br /> Septic Syst ❑Serves 2 20 persooslday Receives other than sanitary wast <br /> eJ <br /> Other Disposal Units Identified: D Dry wells/French Drains <br /> 1Aunits\unit-ImusTUST inspecdona.19.04.00C <br />