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DATE <br /> SAN JOAQUIN COUNTY PR# <br /> ENVIRONMENTAL HEALTH DEPAR•i...ENT PAGE l <br /> 304 E.Weber Ave.,Third Floor, Stockton, CA 95202 <br /> (209)468-3420 <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility Name 1-' �'� Facility Address <br /> Facilty Contacts f Title D Phone# <br /> ��-a�°�-- <br /> UST#� Product__$___ UST#'-Product $� UST#Product!( _UST# Product <br /> Monitoring Panel: -FLST <br /> > 3-Z , � <br /> Overfill Prevention: ❑AudibleNisual XIvlechanical g <br /> Piping System: ❑Gravityressure ❑Suction <br /> Violations: ❑ Minor ❑ Major <br /> Automatic Pum Shut Down Satisfies CCR 2636 ❑Yes o Dis enser Pan: s ❑ No <br /> INSPECTION TYPE: outine ❑Monitoring Certification ❑Complaint ❑Install ❑Removal ❑Repair/Upgrade <br /> COMPANY NAME: <br /> •„TECHNICIAN NAME: PHONE: <br /> VIOLATION(S) <br /> The above facility is not in compliance he following section(s) of <br /> Regulations (CCR): & Safety Code (HSC) and/or <br /> California <br /> 1 HSC 25284 Permit to operate 20 CCR 2712 (b) Maintenance & monitoring <br /> records <br /> 2 CCR 2637 Secondary cont testing (6 <br /> month/36 month) 21 CCR 2636 (f)(4) Annual line tightness test <br /> CCR 2711(b) & (c) Current State Forms A& B 22 CCR 2630 (d) Annual line leak detector tes <br /> 3 <br /> 4 HSC 2711(b) Certification of financial 23 CCR 2630 (d) Annual monitoring certificati, <br /> Daily monitoring of suction <br /> responsibility and letter from 24 CCR 2643 (d) <br /> chief financial officer piping that is not continuous <br /> monitored <br /> 5 CCR 2630 (d) Continuous monitoring system 25 CCR 2643 (d) Triennial tightness test of <br /> for UST system suction piping that is not <br /> 6 CCR 2636 (c)(1) All releases in secondary piping continuously monitored <br /> flow to a collection sump <br /> 7 HSC 25291 (e) Water in secondary(2°)cont 26 CCR 2643 (e) Biennial tightness test uE <br /> piping that is not continuu ous <br /> 8 HSC 25291 (f) Automatic line leak detector(s) monitored <br /> 9-CCR 2636 (f)(1) Continuous monitoring system rade requirements for L <br /> for underground piping 27 CCR 2662 UP9 4 <br /> system <br /> 10 CCR 2632 (c)(2) Continuous monitoring system <br /> for UST 28 CCR 2661 Permit to repair UST syster <br /> 29 HSC 25286 (a) Permit to alter monitoring <br /> 11 HSC 25291(a)(2) Secondary containment for system <br /> UST is tight 30 HSC 25298 (a) Illegal abandonment of US- <br /> 12 CCR 2636 (f)(1) Continuous monitoring system system <br /> for dispenser system <br /> 13 CCR 2635 (b)(1) Spill container 31 HSC 25298 (b) Permit to temporarily close <br /> system <br /> 14 CCR 2635 (b)(2) Overfill prevention system <br /> 32 HSC 25298 (c) Permit to close UST syster <br /> 15 CCR 2631 (a) Primary containment is product- 33 HSC 25291 (e) Water in 20 cont analyzed < <br /> tight properly disposed of <br /> 16 HSC 25292.1 UST system is operated to 34 CCR 2640 (e) Single wall component witt <br /> prevent unauthorized release 1000' of Public Well, no EL <br /> 17 CCR 2650 Recording/reporting <br /> unauthorized release 35 CCR 2635(a)(2)(A)Cathodic protection testing <br /> 36 H&SC 25299(a)(9)Disabling leak detect. devi <br /> 18 CCR 2632 (d) Monitoring &response plan 37 Violation(s) not listed abov <br /> 19 CCR 2712 (i) Monitoring &response plan is <br /> on site <br /> PHONE: <br /> EHD INSPECTOR: <br /> PHONE: <br /> RECEIVED BY: d✓ <br /> X <br /> „dmvn IeMURP(w_v'v-,M) <br />