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SAN JOAQUIN COUNTY <br /> cNVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, California 95202-3029 <br /> Telephone- (209) 468-3420 Fax: (209)468-3433 Web:www.sigov.or /ehd <br /> UNDERGROUND STORAGE TANK (',IST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection <br /> rp4 k NW, 1411- Dater <br /> GS 4q <br /> Facilitaddress: G� UST# <br /> y p <br /> Q /v° -� 1 /L01 � � Product <br /> F rility Contact: ` Title: Phone: <br /> SID <br /> Monitor i Panel: Pi ing system: Overfill prevention:Well a ,441- <br /> ressurized ❑Suction ❑Gravity L Mechanical Audible/visual ❑ <br /> Inspecti ype: Violations: <br /> Routine Monitoring Certification ❑ Installation PCCither 1-RDetect 'M2-RPrev J M-3 Both_ <br /> # Code Section VIOLA 9 IONS) DISC=Cal;fornia Heaith & ty Cade:; CCR=California Code of Regulations V V <br /> _ V=Violation; R =Re eat Violation <br /> 1 HSC 25284 Permit to operate <br /> 2 CCR 2637 Secondary containment test performed 1-51-08 <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 it'(-- <br /> 5 <br /> ts5 CCR 2632 b Monitoring Program (Monitoring & Re_s onse Plan) is current and approved by the local agency, <br /> 6 CCR 2712 i Monitoring Ian is onsite. 0 <br /> 7 CCR 2712 b) Maintenance & monitoring records M1 <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 M1) <br /> 11 CCR 2630 d UST system monitoring equipment is properly located to detect a leak (M1) <br /> 12 HSC 25291 (b) UST system monitoring equipment is operational ffl KLDSUIRI. 4164 AAAWOP'031115(mi) <br /> 13 CCR 2636 (f)(1) Continuous monitoring system for underground piping& UDC is preseNit M1 <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 Line leak detector(s) are installed (M1 <br /> 18 CCR 2635(b)(1) Spill container (M2) <br /> 19 CCR 2635 (b)(2) Overfillrevention s stem M2 <br /> 20 CCR 2636 (a) Conventional suction piping shall have continuous monitorin & 2"containment <br /> 21 HSC 25291 (e) Water in 2 containment analyzed & properly disposed of <br /> 22 CCR 2650 Recording/reporting Recording/reportingof unauthorized releases M1 <br /> 23 CCR 2715 Designated Operator: a Statement from UST owner: (c el Monthly inspection; Employee training <br /> 24 CCR 2638 a Annual monitoring certification <br /> 25 CCR 2638 a Annual line leak detector test $-A-0% (M1) <br /> 26 HSC 25284.2 Annuals ill containment testin <br /> 27 CCR 2636 4 Annual line tightness test <br /> 28 CCR 2661 Repair for tank/piping has had tightness test (M2) S <br /> 29 1 CCR 2643 e Biennial tightness test of gravity piping re-January 1 1984) <br /> 30 CCR 2643 d Triennial line test for conventional suction piping (pre-January 1, 1984) (M1) <br /> 31 HSC 25292.5 Double walls stem located within 1000' of public well-ELD <br /> 32 CCR 2661 Permit to repair UST system __- <br /> 33 HSC 25286 a Permit to alter monitoring system <br /> 34 HSC 25298 b Permit to temporarily close UST system i <br /> 35 HSC 25298 c Permit to close UST system <br /> 36 HSC 25299 Disabling leak detection devices <br /> a 9 2 <br /> 37 HSC 25298 a Illegal abandonment of UST system <br /> 38 Other: 4N.1 — <br /> EHD IN OR _ 6-PA <br /> HONE: �^ UIC <br /> JSeptics sy tem:Serves>_20 people/day <br /> RECEIV BY: ITLE: Receives other than sanitary waste :. <br /> / Other disposal methods. <br /> �fDry wells/French Drains <br /> r- <br /> EHD 23-02-002 REV 8/08 <br />