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SAN JOAQUIN COUNTY <br /> �VIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3rd Floor,Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Fax: (209)468-3433 Web:www.sigov.or /g ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspectioq Date: <br /> Facility address: I <br /> II '' UST <br /> Product <br /> Facility Contac t• Title: Phone: - <br /> Monitoring Panglo Piping system: Overfill prevention: <br /> �C3 Pressurized IJ Suction ❑Gravity Mechanical Audible/visual <br /> Inspection type: iolations: <br /> NRouline MonitoringCertification ❑Installation ❑Other: 1-U-RDetect ❑M2-RPrev ❑M-3 Both <br /> VIOLATION(S) HSC=California Health&Safety Code;CCR California Code of Regulations V R <br /> Code Section V <br /> V=Violation;RV=Re ea[ViolationHSC 25284 Permit too erate <br /> 2 CCR 2637 Secondary containment test..erfortned <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 onse lanis onsite <br /> 7 CCR 2712(b) Maintenance&monitoring records MI <br /> 8 CCR 2643(d) Dail monitoring of suction piping re-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 M1 <br /> I 1 CCR 2630(d) UST system monitoring equipment is properly located to detect a leak MI <br /> 12 HSC 25291 b UST system y monitorin equipment isoperational M2) <br /> 13 CCR 2636 f) 1 Continuous monitoring system for underground piping&UDC is present Ml <br /> 14 CCR 2631 a) Primary containment is pproduct 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 detectors are installed MI <br /> 18 CCR 2635'.(b) I Spill container (142) <br /> 19 CCR 2635(b)(2) Overfill prevention system (M2 <br /> 20 CCR 2636(a) Conventional suction p i in E shall have continuous monitoring&2°containment'. <br /> 21 HSC 25291 (c) Water in 20 containment analyzed&properly disposed of <br /> 22 CCR 2650 Recording/reporting of unauthorizedreleasesMI <br /> 23 CCR 2715 Designate Operator: (a)Statement from UST owner; (c-e)Monthly inspection;( Employee training <br /> 24 CCR 2638 a. Annual Monitoring certification. <br /> 25 CCR 2638(a) Annual line leak detector test (MI) <br /> 26 HSC 25284.2 Annual spill containment testing <br /> 27 CCR 2636(f)(4) Annual line tightness test MI <br /> 28 CCR 2669 (f). Repairp for.tank/piping has had tightness test (M2) <br /> 29 CCR 2643 e Biennial tightness test of gravity piping( re-Januar 1, 1984) <br /> 30CCR 2643 d Triennial line test for conventional suction ppipingg( re-Jams 1, 1984) (MI) <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 monitoring system <br /> 34 HSC 25298(b) 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 s stem <br /> 38 Other: <br /> EHD INSPECTOR: PHONE: UIC <br /> q i yA 6�p�j t`1 Seotic system: <br /> 20L <br /> / ❑Serves>_20 people/day <br /> RE(:EIVED BY: TITLE: ❑Receives other than sanitary waste <br /> Other disposal methods: <br /> tMairiCAAC ❑Dry wells/French Drains <br /> FHD 23-02-002 <br />