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o�puiH \ <br /> SAN JOAQUIN COUNTY • <br /> a Z` ENVIRONMENTAL HEALTH DEPARTMENT <br /> N`• I 304 East Weber Avenue,3 d Floor, Stockton,CA 95202-2708 <br /> Telephone.(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> } �G` 't �1V4 c� tr•Ilr, � ��� <br /> t <br /> Facility address: UST# <br /> Product <br /> Facility Contact: t Title: Phone. <br /> ,i <br /> Monitoring Panel: Piping systeme Overfill prevention: <br /> S Ql Pressurized U Suction U Gravity 0 Mechanical Audible/visual <br /> Inspection type: Violations: <br /> 0 Routine C1J Monitoring Certification U Installation U Other: 1 0 MI-RDetect U M2-RPrcv U M-3 Both <br /> # Code Section <br /> VIOLATION(S) HSC=Califomia Health&Safety Code;CCR=Califomia Code of Regulations V R V=Violation;RV=Re eat Violation V <br /> 1 HSC 25284 Permit to operate <br /> 2 CCR 2637 Secondary containment test performed <br /> 3 CCR 2711 (b)& 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 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 CCR 2632(c)(2) UST monitoring system is present MI <br /> 11 CCR 2630 d UST system monitoring equipment is properly located to detect a leak (Mi) <br /> 12 HSC 25291 UST system monitoring 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 product 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 f) Line leak detector(s)are installed (MI) <br /> 18 CCR 2635 1 Spill container (M2 <br /> 19 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 IV <br /> 22 CCR 2650 Rccording/reporting of unauthorized releases (MI) <br /> 23 CCR 2715 Designated Operator.(a)Statement from UST owner; (c-e)Moodily inspection; f)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 Annuals ill containment testing <br /> 27 CCR 2636(f)(4) Annual line tightness test I) <br /> 28 CCR 2661 Repair for tank/piping has had tightness test M2 <br /> 29 CCR 2643(e) Biennial tightness test of gravity pipingre-Jana 1, 1984 <br /> 30 1 CCR 2643 d Triennial line test for conventional suction piping- re-Jana 1, 1984 Ml <br /> 31 1 HSC 25292.5 Double walls stem located within 1000'of public well-ELD <br /> 32 1 CCR 2661 - Permit to repair 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 /> 36 HSC 25299(a)(9) Disabling leak detection devices <br /> 37 HSC 25298(a) Illegal abandonment of UST system <br /> 38 Other: <br /> EHD INSPECTOR: PHONE: UIC <br /> Septic system: <br /> IJ Serves 2:20 people/day <br /> t <br /> RECEIVED By: TITLE: 1 U Receives other than sanitary waste <br /> Other disposal methods: <br /> if U Dry wells/French Drains <br /> EHD 23-02 <br /> 1/3/07 <br />