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- RECO ED <br /> SAN JOAQUIN COUNTY U 4 2008 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton,California 95202-3029 tt�VIRUNNAENT HEAL1� <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sj ov.org/ehd'� p )AI�15ERUICES <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> Facility address: <br /> UST# ' <br /> 1 -/ 1 <br /> � Product <br /> Facility Contact: Title: Phone: <br /> C7 09 9 <br /> Mopitorinp Panel,' Piping system: Overfill prevention: <br /> ressurized ❑Suction ❑Gravity echanical ❑Audible/visual <br /> Inspection type: Violations: <br /> ti+Routine L l monitoring Certification El Installation El Other: ❑M I-RDetect ❑M2-RPrev ❑M-3 Both <br /> VIOLATION(S) HSC=California Health&Safety Code;CCR=California Code of Regulations V R <br /> # Code Section g <br /> V=Violation; RV=Re eat Violation V <br /> 1 HSC 25284 Permit tooperate <br /> 2 CCR 2637 Secondary containment test performed <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 "" <br /> 5 CCR 2632 b) Monitorin Program(Monitoring&Response Plan)is current and approved by the local agency. <br /> 6 CCR 2712(i) Monitorin plan is onsite. <br /> 7 CCR 2712 b Maintenance&monitoring records M1 <br /> 8 CCR 2643 d) Daily monitoring of suction piping(pre-January, I, 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 /> I I CCR 2630 d) UST system monitoring equipment is properly located to detect a leak (M1 <br /> 12 HSC 25291 b) UST system monitoring equipment isoperational (M2) <br /> 13 CCR 2636(1)(1) Continuous monitoring system for underground piping&UDC is present 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 piping flow to a collection sum <br /> 17 HSC 25291 Line leak detector(s)are installed M 1) <br /> 18 CCR 2635(b)(1) Spill container (M2) <br /> 19 CCR 2635(b)(2) Overfill prevention system (M2) <br /> 20 CCR 2636(a) Conventional suction piping shall have continuous monitoring&2°containment <br /> 21 HSC 25291 (e) Water in 2°containment analyzed&properly disposed of <br /> 22 CCR 2650 Record in /re orti ng of unauthorized releases (M1) <br /> 23 CCR 2715 Designated Operator: (a)Statement from UST owner; (c-e)Monthly inspection-, t)Employee training <br /> 24 CCR 2638 a) Annual monitoring certification <br /> 25 CCR 2638(a) Annual line leak detector test (Ml) <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636(t)(4) Annual line tightness test M1) <br /> 28 CCR 2661 (t) Repair for tank/piping has had tightness test (M2) <br /> 29 CCR 2643 e) Biennial tightness test of gravity piping(pre-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 `ublic 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 <br /> 35 HSC 25298 c) Pen-nit to close UST system <br /> 36 HSC 25299(a)(9) Disabling leak detection devices _ <br /> 37 1 HSC 25298 a) Illegal abandonment of UST s stem l <br /> 38 1 Other: <br /> EHD INSPECTOR: c� PHONE: f J6 UIC <br /> ��04) "i _ c � t Septic s"s�_n: <br /> s res` f' -Serves>20,people/day <br /> RECEIVED.BV / TITLE: Receivesothe"t[wsanitary waste <br /> _ Other disposal methods: <br /> R -Dry wells/French Drains <br /> I <br /> r. <br /> EHD 23-02-002 REV 05/07 <br />