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Y SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,California 95202-3029 <br /> Telephone.(209)468-3420 Fax.(209)468-3433 Web:www.sisov.org/ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> 0 #/F/0 <br /> Facility address: UST I / <br /> SIle v -Product 4 <br /> Facility Ninev Title: Phune: <br /> ✓�Q <br /> Moni ring Psnel: Piping system: Overfill prevention: <br /> essurized U Suction U Gravity U Mechanical udible/visual <br /> Inspection type: Violations: <br /> outine 'IRMornitoring Certification U Installation U Other: U MI-RDetect U M2-RPrev U M-3 Both <br /> # Code Section <br /> VIOLATION(S) HSC=Califomia Health&Safety Code;CCR=California Code of Regulations V R <br /> V=Violation;RV=Rcpmt Violation V <br /> I HSC 25284 Permit tooperate <br /> 2 CCR2637 Secondarycontainment 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 Monitoring Program(Monitoring&Response Plan)is current and approved by the local agency. <br /> 6 CCR 2712 i Monitoring Ian is onsite. <br /> 7 CCR 2712 6 Maintenance&monitoringrecords Ml <br /> 8 CCR 2643 d) Daily monitoring of suction piping(pre-January, I, 1984) <br /> 9 HSC 25292.1 UST s stem is operated to prevent unauthorized release <br /> 10 CCR 2632(c)(2) UST monitoring system is present (M I) <br /> 1 I CCR 2630 d UST system monitoring equipment is properly located to detect a leak M t) <br /> 12 HSC 25291 b) UST system monitoring equipment isoperational M2) <br /> 13 CCR 2636 I Continuous monitoring system for underground piping&UDC is present (MI <br /> 14 CCR 2631 a Primary containment is product tight <br /> 15 HSC 25291 (a)(2) Secondarycontainment 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 preventionsystem M2) <br /> 20 CCR 2636(a) Conventional suction piping shall have continuous monitoring&20 containment <br /> 21 HSC 25291 (e) Water in 20 containment analyzed&properly disposed of <br /> 22 CCR2650 Recordin r ortin of unauthorized releases (M l) <br /> 23 CCR 2715 Desi oared O erator a)Statement om 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 (M I) <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636(1)(4) Annual line tightness test MI) <br /> 28 CCR 2661 t) Repair for tank/piping has had tightness test (M2) <br /> 29 CCR 2643 e) Biennial it htness test of gravity piping(pre-January 1, 1984) <br /> 30 CCR 2643 d) Triennial line test for conventional suction piping(pre-January I, 1984) (M 1) <br /> 31 HSC 25292.5 Double wall system 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 <br /> 35 HSC 25298 c Permit to close UST system <br /> 36 HSC 25299(a)(9) Disabling leak detection devices <br /> 37 HSC 25298 a Illegal abandonment of UST system <br /> 38 1 Other: <br /> EHD INSPECTOR: PHONE: UIC <br /> Septic system: <br /> 11M 'T[� �+ CJ b -Serves 220 people/day <br /> RECEIV TITLE: -Receives other than sanitary waste <br /> Other� D y well methods:wells/French Drains <br /> EHD 23-02-002 REV 05/07 <br />