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,` • DATE <br /> SAN JOAQUIN COUNTY • PR# <br /> ENVIRONMENTAL HEALTH DEPARTMENT PAGE <br /> 304 E.Weber Ave.,Third Floor, Stockton, CA 95202 <br /> (209)468-3420 <br /> DUNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br /> Facility Name I nn� ,�� , / Facility Address Gtl1/� L� <br /> Facilty Contact ZEN L /� d2 _Title S Phone # <br /> UST# ProductQ� UST#�Product��1_UST# 3Product �d UST#_Product <br /> Overfill Prevention: 0Audible/Visual q,fechanical Monitoring Panel: <br /> Piping System: 0 Gravity 0 Pres re 0 Suction Viol ations:AM1-RDet M2-Rpr v D M3-Both <br /> Automatic Pum Shut Down Satisfies CCR 2636(f)(5): 0 Yes O No Designated Operator: <br /> �— <br /> INSPECTION TYPE: Routine pWnitoring Certification OComplaint Dinstall ❑Removal ❑Repair/Upgrade <br /> COMPANY NAME: TECHNICIAN NAME:r!( ONE: <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 24CCR 2636 (a) Conventional suction piping <br /> 4yHSC 25292.2 Certification of financial shall have continuous <br /> responsibility& CFO letter monitoring & 20 containment <br /> 5 CCR 2632 (c)(2) UST monitoring is present(M1) 25 CCR 2643 (e) Biennial tightness test of gravit <br /> 6_CCR 2630 (d) UST system monitoring piping (pre-1/1/84) <br /> equipment is properly located to 26 CCR 2643 (d) Triennial line test for <br /> detect a leak (M1) conventional suction (pre- <br /> 7 V HSC 25291 (b) UST system monitoring 1/1/84) (M1) <br /> equipment is operational (M1) 27 CCR 2661 Permit to repair UST system <br /> 8 CCR 2636 (f)(1) Continuous monitoring system 28 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 US <br /> 10 HSC 25291 (f) Line leak detector(s)(M1) system <br /> 11 HSC 25291(a)(2) Secondary containment for 31_HSC 25298 (c) Permit to close UST system <br /> UST is tight 32 HSC 25292.1 UST system is operated to <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 /> unauthorized release M1 <br /> 14 CCR 2635 (b)(2) Overfill prevention system (M2) ( <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__V CCR 2632 (c)(2)(D)Monitoring &response plan 35 CCR 2640 (e) Single wall component within <br /> 17 CCR 2712 (i) Monitoring & response plan is 1 000' 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_HSC 25299(a)(9) Disabling leak detect. Devices <br /> 19__V_CCR 2636 (f)(4) Annual line tightness test 38_CCR 2715(a) Statement from UST owner <br /> 20 %./ 2638 (a) Annual line leak detector test 39_CCR 2715(c) Monthly inspection by D.O, <br /> (M1) 40_CCR 2715(f) D.O. trained employees <br /> 21 CCR 2638 (a) 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 c, y <br /> iRECtIBY: <br /> CTOR: PHONE: <br /> TITLE: FtW- acit4��S� <br /> Septic System: D Serves 2 20 persons/day ❑Receives other than sanitary Waste <br /> Other Disposal Units Identified: D Dry wells/French Drains <br /> uku.iFOhusTUST insp uon9.15.04.DOC <br />