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• o$QuiN <br /> ' c . SAN JOAQUIN COUNTY • <br /> 2 • °i <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> caC oRN P 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 /> f�wl� ` 0 o <br /> Facility address:� 1�.yr UST#Iva � � vi Ni I <br /> Product <br /> Facility Contact: Title: Phone: <br /> Mon torin Panel: Piping system Overfill prevention: <br /> V �4 V Pressurized ❑Suction ❑Gravity ❑Mechanical Audible/visual <br /> Inspection type: violations: <br /> Routine Monitoritru Certification ❑Installation ❑Other: ❑MI-RDetect ❑M2-RPrev ❑M-3 Both <br /> # Code Section VIOLATIONS) HSC=Califomia Health&Safety Code;CCR=California Code of Regulations V R <br /> 1 HSC 25284 Permit too crate V=Violation;RV=Re eat Violation V <br /> 2 CCR 2637 Second2a containment test erformed <br /> 3 CCR 2711 & 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 MonitonnE&response plan is current and filed with the local agency <br /> 6 CCR 2712 i .--i.-ring&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 is operated to 2revent unauthorized release <br /> 10 CCR 2632(c)(2) UST monitoring system is present Ml <br /> 111 CCR 2630(d) UST system monitoring equipment is properIx located to detect a leak (Mi) <br /> 12 HSC 25291 UST system monitoring a ui ment isoperational M2 <br /> 13 CCR 2636 1 Continuous monitoring system for underground piping&UDC is present (Mi) <br /> 14 CCR 2631 a Primar 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) I Line leak detector(s)are installed MI <br /> 18 CCR 2635 1 S ill container MZ <br /> 19 CCR 2635 )(2)1— Overfill revention 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 <br /> 22 CCR 2650 Recording/reporting of unauthorized releases MI <br /> 23 CCR 2715 1 Designated Operator: a Statement from UST owner; (c-e)Monthly inspection;(f)Employee trainin <br /> 24 CCR 2638 a Annual monitoringcertification <br /> 25 CCR 2638(a Annual line leak detector test Ml <br /> 26 HSC 25284.2 Annuals ill containment testin <br /> 27 CCR 2636 f) 4 Annual line ti htness test Ml <br /> 28 CCR 2661 Re air for tank/piping in has had tightness test M2 <br /> 292643 a Biennial ti htness test of gravityi in ( re-Januar 1, 1984 <br /> 30 CCRCCR 2643 d Triennial line test for conventional suction piping re-Januar1, 1984 M1 <br /> 31 HSC 25292.5 Double walls stem located within 1000'of public well-ELD <br /> 32 CCR 2661 Permit to re air UST system <br /> 33 HSC 25286 a Permit to alter monitoringsystem <br /> 34 HSC 25298 Permit to temporarily close UST system <br /> 35 HSC 25298 c) Permit to close UST system <br /> 36 1 HSC 25299(a)(9) Disablin leak detection devices <br /> 37 HSC 25298 a Il le al abandonment of UST system <br /> 38 Other: <br /> E}aIINS ECTOR: PHONR: UIC <br /> 4 /� S Septic system <br /> RECEI ❑Serves>_20 people/day <br /> T1TL E: ❑Receives other than sanitary waste <br /> Other disposal methods* <br /> 11 Dry wells/French Drains <br /> EHD 23-02 IjW,I sL <br /> I/1/r17 <br />