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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.sicehd.com <br /> UNDERGROUND STORAGE TANK UST PROGRAM INSPECTION REPORT <br /> Facility \U S nr Facility ^ �C� S �� � Inspection 3 l� <br /> Name: '- `V Address: � �� \Z- Date: ;t�E' <br /> Non-Pressurized Piping V R COS <br /> 401 CCR 2636(a)(3) Suction piping not properly sloped or incorrectly located check valve(V705) ❑ ❑ ❑ <br /> 402 CCR 2643(d) Daily monitoring of suction pipe(pre-Jan 1984)not performed(V726) ❑ ❑ ❑ <br /> 403 CCR 2643(d) Triennial 0.1 gph line test for conventional suction piping not performed(pre-January 1984)(V664) ❑ ❑ ❑ <br /> 404 CCR 2643(e) Biennial 0.1 gph test for gravity piping not performed(pre-January 1984)(V665) ❑ ❑ ❑ <br /> Other Violations V R COS <br /> 2010 See below Unlisted Administration/Documentation violation(V736) ❑ tl] LL� <br /> 2030 See below Unlisted Operations/Maintenance violation(V743) 1.12060 See below Unlisted Design/Construction violation(V745) <br /> SUMMARY OF VIOLATIONS <br /> (CLASS I, CLASS II, or MINOR-Notice to Comply <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 FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> Received by(signature): Title: Date: <br /> Received by(printed name): Inspector: Inspector phone: <br /> C I ce-- (��"C)r_ � p�Cjcl - 'JC; 3�S 3 <br /> EHD 23-01 REV 07/28/16 Page 3 UST INSPECTION REPORT <br />