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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.sigov.org/ehd <br /> UNDERGROUND STORAGE TANK UST PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection <br /> tiJd�4('t'f C)/Ci Date <br /> 1 Z 11 0 (o l <br /> Facility address: <br /> UST# 1� cjo 16 <br /> Facility Contact: Title: Phone: Product 87 <br /> l,/Q <br /> 0 wnpz <br /> o i onng Panel: Piping system: Overfill prevention: <br /> t VJA L4 F Pressurized ❑Suction ❑Gravity )(Mechanical ❑Audible/visual <br /> rRoutilne <br /> cion type: <br /> Violations: <br /> ❑Monitoring Certification ❑Installation ❑Other: M1-RDetect ❑M2-RPrev ❑M-3 Both <br /> Code Section VIOLATIONS) HSC=California Health &Safety Code; CCR=California Code of Regulations V R <br /> V=Violation; RV=Re eat Violation V <br /> 1 HSC 2'5284 Permit tooperate <br /> 2 CCR 2637 Secondary containment test performed <br /> 3 CCR 2711 ti & 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 aenc . <br /> 6 CCR 2712 i MonitoringIan is onsite. <br /> 7 CCR 2712 b Maintenance& monitoring records M1) <br /> 8 CCR 2643 d Daily monitorino 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 (M1) <br /> 13 CCR 2636(f)(1) Continuous monitorings stem for underground piping & UDC is present (M1) <br /> i4 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 f Line leak detector(s)are installed (M1) <br /> 18 CCR 2635(b)(1) Spill container (M2) <br /> 19 CCP,-2635(b)(2) Overfill prevention system (M2) <br /> 20 CCR 2636(a) Conventional suction piping shall have continuous monitoring &21 containment <br /> 21 HSC 25291 (e) Water in 21 containment analyzed & properly disposed of <br /> 22 CCR:650 Recording/reporting of unauthorized releases M1) <br /> 23 1 CCR 2715 Designated Operator: a Statement from UST owner; (Lc-6)Monthly inspection; Employee training <br /> 24 CCR 2638 a Annual monitoring certification <br /> 25 CCR 2638 a Annual line leak detector test (M1) <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636 (f)(4) Annual line tightness test (Mill <br /> 28 CCR 2661 f Repair for tank/piping has had tightness test (M2) <br /> 29 CCR 2643 a 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 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 Disabling leak detection devices <br /> a 9 f 2 <br /> 37 HSC 25298 a illegal abandonment of UST system <br /> 38 Other: _ <br /> EHD INSPECTOR: PHONE: /^ G(�/A(� UIC <br /> A �d IJ r L 06 l Z0,9 L4 o -1 0 `/O Se ' s stem: <br /> C'Se?res.,?20 people/day <br /> RECEIVED BY: TITLE: F Receivesbther than sanitary waste <br /> Other disposal mef*s <br /> 1� i Dry wells/French Drains <br /> EHD 23-02-002 REV 8/08 <br />