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DATE Z L� <br /> PUL HEALTH SERVICES SAN JOAQU. OUNTY PR# <br /> ENVIRONMENTAL:HEALTH DIVISION PAGE <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 L �� Facility Address I -"I - I <br /> Facilty Contact�� &C 4'1 <br /> Title ,q;� Phone # <br /> UST#_-L Product f"�c I UST#Product l� I UST#_Product UST# Product <br /> Overfill Prevention: AudibleNisual �echanicah Monitoring Panel: +ice <br /> Piping System: Gravity Pressure, Suction - , Violations: PL (IC/lajo <br /> Automatic Pump Shut Down Satisfies.CCR 2636(g): ( Yes No Dispenser Pan: Yes N-o <br /> INSPECTION TYPE: Routine Monitoring Certification Complaint Install Removal Repair/Upgrade <br /> COMPANY NAME: ? TECHNICIAN NAME: PHONE: <br /> VIOLATION(S) <br /> The above facility is not in compliance with the following section(s) of Health & Safety Code (HSC) and/or <br /> California Code of Regulations (CCR): <br /> 1 HSC 25284 Permit to operate 19 v _CCR 2712 (i) Monitoring & response plan <br /> 2 CCR 2637 Secondary cont testing (6 j is on site <br /> month/36 month) 20y CCR 2712 (b) Maintenance & monitoring <br /> 3 CCR 2711(b) & (c) Current State Forms A & B records <br /> 4 HSC 25292.2 Certification of financial 21 CCR 2636 (f)(4) Annual line tightness test <br /> responsibility and letter from 22 v/ CCR 2630 (d) Annual line leak detector test <br /> chief financial officer 23 CCR 2630 (d) Annual monitoring <br /> 5 V/ CCR 2630 (d) Continuous monitoring certification <br /> system for UST system 24 CCR 2643 (d) Daily monitoring of suction <br /> 6 CCR 2636 (c)(1) All releases in secondary piping that is not <br /> piping flow to a collection continuously monitored <br /> sump 25 CCR 2643 (d) Triennial tightness test of <br /> 7 HSC 25291 (e) Water in secondary (20) cont suction piping that is not <br /> 8 HSC 25291 (f) Automatic line leak continuously monitored <br /> detector(s) 26 CCR 2643 (e) Biennial tightness test of <br /> 9 CCR 2636 (f)(1) Continuous monitoring gravity piping that is not <br /> system for underground continuously monitored <br /> piping 27 CCR 2662 Upgrade requirements for <br /> 10 CCR 2632 (c)(2) Continuous monitoring UST system <br /> system for UST 28 CCR 2661 Permit to repair UST system <br /> 11 HSC 25291(a)(2) Secondary containment for 29 HSC 25286 (a) Permit to alter monitoring <br /> UST is tight system <br /> 12 CCR 2636 (f)(1) Continuous monitoring 30 HSC 25298 (a) Illegal abandonment of UST <br /> system for dispenser system system <br /> 13 CCR 2635 (b)(1) Spill container 31 HSC 25298 (b) Permit to temporarily close <br /> 14 CCR 2635 (b)(2) Overfill prevention system UST system <br /> 15 CCR 2631 (a) Primary containment is 32 HSC 25298 (c) Permit to close UST system <br /> product-tight 33 HSC 25291 (e) Water in 20 cont analyzed <br /> 16 HSC 25292.1 UST system is operated to and properly disposed of <br /> prevent unauthorized release 34 CCR 2640 (e) Single wall component within <br /> 17 CCR 2650 Recording/reporting 1000' of Public Well, no ELD <br /> unauthorized release 36 CCR 2635(a)(2)(A) Cathodic protection testing <br /> 18 Z CCR 2632 (d) Monitoring & response plan 35 Violation(s) not listed above <br /> EHD INSPECTOR: - � <br /> PHONE: %- <br /> RECEIVED BY: TITLE• . � PHONE: 9 — pC <br /> UNITIII/UST/INSP(rev 12/19/01) <br />