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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sacehd.com <br />UNDERGROUND STORAGE TANK UST PROGRAM INSPECTION REPORT <br />-v— <br />FacilityFacility <br />Name: l l <br />11`r <br />a '! <br />Address: j � � <br />Inspection �/ <br />Date: �_2q_l <br />SUMMARY OF VIOLATIONS <br />CLASS I, CLASS II, or MINOR — Notice to Comply <br />Non -Pressurized Piping <br />V <br />R <br />COS <br />402 <br />CCR 643(d) <br />Daily monitoring of suction pipe (pre -Jan 1984) not performed (V726) <br />❑ <br />❑ <br />❑ <br />403 <br />CCR 2643(d) <br />Triennial 0.1 gph line test for conventional suction piping not performed (pre -January 1984) (V664) <br />❑ <br />❑ <br />❑ <br />404 <br />CCR 2643(e) <br />Biennial 0.1 gph test for gravity piping not performed (pre -January 1984) (V665) <br />❑ <br />❑ <br />❑ <br />Other Violations <br />V <br />R <br />COS <br />2010 <br />See below <br />Unlisted Administration/Documentation violation (V736) <br />❑ <br />❑ <br />❑ <br />2030 <br />See below <br />Unlisted Operations/Maintenance violation (V743) <br />❑ <br />❑ <br />❑ <br />2060 <br />See below <br />Unlisted Design/Construction violation (V745) <br />❑ <br />❑ <br />❑ <br />SUMMARY OF VIOLATIONS <br />CLASS I, CLASS II, or MINOR — Notice to Comply <br />v 't') ewe I <br />ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RATE. <br />THIS FACIL TY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHUS CURRENT HOURL RATE. <br />Received by: <br />Title: <br />Date: 2 /n / <br />Inspector: <br />Title <br />Date: <br />EHD 23-01 REV 08/01/14 Page 3 UST iNSPE i iON REPORT <br />