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SAN JOAQUIN COUNTY DATE J P R# VIRONMENTAL HEALTH DEPAR'► :NT PAGE Z 304 E. Weber Ave., Third Floor, Stockton, CA 95202 (209)468-3420 UNDERGROUND STORAGE TANK (UST)-PROGRAM INSPECTION REPORT Facility Name-,!5 (jOff:;I(t? -Facility AddressZ�8 Facilty Contact�,OW:�� ,SC 7 Title Phone #C?Z.r) zf-,69- ;?r-;o6UST# Product F.Ul, UST# ?-Product Ftj G-, # Product MUL—UST# Product Overfill Prevention: YAudible/Vis al 11 Mechanical Monitoring Panel: -A TLS- V3QZ.— Piping System: El Gravity I�Pressure ❑ Suction / Violations: ElM1-RDet ElM2-Rprev 11M3-Both Automatic Pum Shut Down Satisfies CCR 2636 (f)(5): fl Yes ❑ No Designated Operator: INSPECTION TYPE: ❑Routine ❑Monitoring 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 23 CCR 2643 (d) Daily monitoring of suction 2�-CCR 2637 Secondary cont. testing piping (pre-1/1/84) 3 CCR 2711(b) & (c) Current State Forms A& B 24 CCR 2636 (a) Conventional suction piping 4 HSC 25292.2 Certification of financial shall have continuous responsibility& CFO letter monitoring &20 containment 5 CCR 2632 (c)(2) UST monitoring is present (M1) 25 CCR 2643 (e) Biennial tightness test of gravit, 6 CCR 2630 (d) UST system monitoring piping (pre-1/1/84) equipment is properly located to 26 CCR 2.643 (d) Triennial line test for detect a leak (M1) conventional suction (pre- 7 CCR 2637(b) UST system monitoring 1/1/84) (M1) equipment is operational (M1) 27 CCR 2661 Permit to repair UST system 8 CCR 2636 (f)(1) Continuous monitoring system 28 HSC 25286 (a) Permit to alter monitoring for underground piping & UDC system is present(M1) 29 HSC 25298 (a) Illegal abandonment of UST 9 CCR 2636 (c)(1) All releases in secondary piping system flow to a collection sump 30 HSC 25298 (b) Permit to temporarily close US- 10 HSC 25291 (f) Line leak detector(s) (M1) system 11 HSC 25291(a)(2) Secondary containment for 31 HSC 25298 (c) Permit to close UST system UST is tight 32 HSC 25292.1 UST system is operated to 12 CCR 2635 (b)(1) Spill container (M2) prevent unauthorized release 13 HSC 25284.2 Annual spill container testing 33 CCR 2650 Recording/reporting 14 CCR 2635 (b)(2) Overfill prevention system (M2) unauthorized release (M1) 15 CCR 2631 (a) Primary containment is product-. 34 HSC 25291 (e) Water in 20 cont analyzed and tight properly disposed of 16 CCR 2632 (d) Monitoring & response plan 35 CCR 2640 (e) Single wall component within 17 CCR 2712 (i) Monitoring & response plan is 1000' of Public Well, no ELD on site 36 CCR 2635(a)(2)(A)Cathodic protection testing & 18 CCR 2712 (b) Maintenance & monitoring 60 day inspection log (M2) records (M1) 37 H&SC 25299(a)(9)Disabling leak detect. Devices 19 CCR 2636 (f)(4) Annual line tightness test 38 CCR 2715(x) Statement from UST owner 20 CCR 2630 (d) Annual line leak detector test 39 CCR 2715(c) Monthly inspection by D.O, (M1) 40 CCR 2715 (f) D.O. trained employees 21 CCR 2630 (d) Annual monitoring certification 41 Violation(s) not listed above 22 CCR 2661 (f) Repair for tank/piping has had tightness test M2 EHD INSPECTOR: PHONE: �G! RECEIVED BY: TITLE: Septic System: ❑Serves Z 20 persons/day ❑Receives other than sanitary waste Other Disposal Units Identified: ❑Dry wells/French Drains 1:1Units\Unit-111\UST\UST inspecbon8.19.04.DOC