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SAN JOAQUIN COUNTY • <br /> • OVIRONMENTAL HEALTH DEPARTS <br /> 304 East Weber Avenue,3"Floor, Stockton,CA 95202-2708 <br /> Telephone: (209)468-3420 Fax:(209)468-3433 Web:www sieov.or /g ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Designated Operator: Inspection Date: <br /> Facility name: <br /> L' cy Gas -4 oe CVAM ►L/��ob <br /> Facility address: UST#- - , Com' <br /> u�4Uo g t►w•! � M - Product 67 D/ 9 <br /> Facility Contact: Title: Phone: - <br /> 3kw 6lNGH Ow►Je-R � <br /> Monitoring Panel: Piping system: Overfill prevention: <br /> V4 9-115 NPressurized D Suction D Gravity (Mechanical D Audible/visual <br /> Violations: <br /> Inspection type: __// <br /> f9f ouline "onitorin Certification D Installation D Other: D Ml-RDetect D M2-RPrev D M-3 Both <br /> # Code Section VIOLATIONV R <br /> S) HSC=Califomia Health&Safety Code;CCR=Califomia Code of Regulations V <br /> V=Violation;RV=Re eat Violation <br /> 1 HSC 25284 Permit too erate <br /> 2 CCR 2637 Second containment test nerthrmed <br /> 3 CCR 2711 b & c Current Unified Pro am 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 a enc <br /> 6 CCR 2712(i) Monitoring&response plan is onsite <br /> 7 CCR 2712 b Maintenance&monitoringrecords (MI) <br /> 8 CCR 2643 d Daily monitoring of suction piping(pre-iana , 1, 1984 <br /> 9 HSC 25292.1 UST system isoperated to prevent unauthorized release <br /> 10 CCR 2632 c 2 UST monitoringsystem is resent Ml <br /> 1 I CCR 2630 d UST system monitoringequipment is properly located to detect a leak Ml <br /> 12 HSC 25291 UST s tem monitoringequipment iso rational M2 <br /> 13 CCR 2636 1 Continuousmonitorin s stem for underground piping&UDC is resent Ml <br /> Pri <br /> 14 CCR 2631 a containment is roduct ti ht <br /> 15 HSC 25291 a 2 Secondary containment for UST is ti ht <br /> 16 CCR 2636(c 1 All releases in second piin fl,--"- <br /> 17 HSC 25291 Line leak detector(s)are installed Ml <br /> I8 CCR 2635 b 1) S ill container (M2 <br /> 19 CCR 2635 b 2 Overfill revention s stem M2 <br /> 20 CCR 2636(a) Conventional suction Liping shallhave continuous monitoring&20 containment <br /> 21 HSC 25291 (e) Water in 20 containment analyzed&properly disposed of <br /> 22 CCR2650Recording/reporting of unauthorized releases Ml <br /> 23 CCR 2715 Designated Operator:(a)Statement from UST owner; (c-e)Monthly inspection; Employee trainin ✓ <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 I, 1984 <br /> 30 CCR 2643(d) Triennialline test for conventional suction i p in (pre-January 1, 1984 (Ml <br /> 31 HSC 25292.5 Double walls stem located within 1000'ofpublic well-ELD <br /> 32 CCR 266) Fermit tote air UST system <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 /> `36HSC 25299 a 9 Disablingteak detection devices <br /> 37 HSC25 298 a Illegal abandonment of UST system <br /> 38 1 Other: <br /> EHD INSPECTOR: PHONE: UIC <br /> 3C Septic system: <br /> t � jj,(/L V U \ �Serves>_20 people/day <br /> RECEIVED BY: TITLE: El Receives other than sanitary waste <br /> Other disposal methods <br /> C.Dry wells/French Drains <br /> Fun?1_0z-nm <br />