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E C>, SAN JOAQUIN COUNTY P DATT .✓IRONMENTAL HEALTH DEPARTn. ..JT PAGE \ of a, 304 E. Weber Ave., Third Floor, Stockton, CA 95202 (209)468-3420 UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT Facility Name Facility Address_'fq%-N w. Facilty Contact_C� ,��p, � Title Fx, Phone# y" b-\4k\-'aokac6 UST# \ Product t-� UST# D-- Product %q UST# 3 Product UST# Product Overfill Prevention: f/Audible/Viyal ❑ Mechanical Monitoring Panel:— Piping anel:\Piping System: ❑ Gravity K Pressure ❑Suction Violations: inor El Major Automatic Pum Shut D wn Sati ies CCR 2636 /Yes El No Dispenser Pan: ?es ❑ No INSPECTION TYPE: Aoutine 6fionitoring Certification ❑Complaint ❑Install ❑Removal ❑Repair/Upgrade COMPANY NAME: TECHNICIAN NAME: PHONE: VIOLATION(S) The above facility is not in compliance with the following section(s) of Health & Safety Code (HSC) and/or California Code of Regulations (CCR): 1 HSC 25284 Permit to operate 20 CCR 2712 (b) Maintenance & monitoring 2 CCR 2637 Secondary cont testing (6 records month/36 month) 21 CCR 2636 (f)(4) Annual line tightness test 3�CCR 2711(b)& (c) Current State Forms A& B 22 CCR 2630 (d) Annual line leak detector test 4 �, HSC 25292.2 Certification of financial 23 CCR 2630 (d) Annual monitoring certification responsibility and letter from 24 CCR 2643 (d) Daily monitoring of suction chief financial officer piping that is not continuously 5 CCP.2630 (d) Continuous monitoring system monitored for UST system 25 CCR 2636 (a) Conventional suction piping 6 CCR 2636 (c)(1) All releases in secondary piping shall have continuous flow to a collection sump monitoring &20 containment 7 HSC 25291 (e) Water in secondary(2°) cont 26 CCR 2643 (e) Biennial tightness test of gravity 8 HSC 25291 (f) Automatic line leak detector(s) piping that is not continuously 9 CCR 2636 (f)(1) Continuous monitoring system monitored for underground piping 27 CCR 2662 Upgrade requirements for UST 10 CCR 2632 (c)(2) Continuous monitoring system system for UST 28 CCR 2661 Permit to repair UST system 11 HSC 25291(a)(2) Secondary containment for 29 HSC 25286 (a) Permit to alter monitoring UST is tight system 12 CCR 2636 (f)(1) Continuous monitoring system 30 HSC 25298 (a) Illegal abandonment of UST for dispenser system system 13 CCR 2635 (b)(1) Spill container 31 HSC 25298 (b) Permit to temporarily close UST 14 CCR 2635 (b)(2) Overfill prevention system system 15 CCR 2631 (a) Primary containment is product- 32 HSC 25298 (c) Permit to close UST system tight 33 HSC 25291 (e) Water in 20 cont analyzed and 16 HSC 25292.1 UST system is operated to properly disposed of prevent unauthorized release 34 CCR 2640(e) Single wall component within 17 CCR 2650 Recording/reporting 1 000'of Public Well, no ELD unauthorized release 35 CCR 2635(a)(2)(A)Cathodic protection testing 187CCR 2632 (d) Monitoring & response plan 36 H&SC 25299(a)(9)Disabling leak detect. devices 19 CCR 2712 (i) Monitoring & response plan is 37 Violation(s)not listed above on site EHD INSPECTO PHONE: RECEIVED BY: TITLE: �L M IM14dtI- UNITIII/UST/INSP(rev 724/02)