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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, California 95202-3029 Telephone: (209) 468-3420 Fax: (209)468-3433 Web:www.sigov.org/ehd/unitiii.html UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT Facility name: Inspection date: -4 f4m NW-ret xt-�Lg lC) Facility address: UST#/ Product Facility contact 0 II y Title:�ry�— Phone: 0 1:�-N-2, yj Monitoring panel: Piping system: Overfill pr vention: Violations: VP— 'f�� j ��0 Pressurized Suction ❑Gravity [I Mechanical M1-RDetect -RPrev 11M-3 Both V � Audible/visual Inspection type: Designated operator: ICC exp.date: outine monitoring Certification Installation Other: Q '/t�t,Z 6 On site Service Technician's name: ICC exp.date: Manufacturer's raining: /NA # Code Section HSC=CA Health&SafetyCode; CCR=CA Code AoflRes V Regulations; V=Violation; RV=Re eat Violation V 1 HSC 25284 No permit tooperate Secondary containment: (a)test not performed; (e)test report not submitted within 30 days; (f)test 2 CCR 2637 notification not provided to the Environmental Health Department(EHD)at least 48 hours prior to conducting the test 7 2 u06 I X1 I Oq 3 CCR 2711 b & c Current Unified Program Consolidated Forms not on file with the EHD (Facility and tank form 4 HSC 25292.2 Current financial responsibility documents not on file with the EHD 05 10 Qq 5 CCR 2632(b) Monitoring Program (Monitoring & Response Plans) is not current or approved by the EHD 6 CCR 2712(i) Monitoring and/or response plan is not onsite Maintenance& monitoring records not maintained 3 years, cathodic protection records for 6'/2 (M1) years,written performance claims pertaining to release detection systems for 5 years, or records of repairs, linings, and upgrades for the life of the tank. Monitoring records include: (1)date and time of 7 CCR 2712(b) all monitoring or sampling; (2) monitoring equipment calibration and maintenance records; (3) results of any visual observations; (4) results of sample analysis performed a lab or in the field; (5) logs of all readings of gauges or other monitoring equipment,ground water elevations, or other test results; (6) results of inventory readings and reconciliations 8 CCR 2643(d) Daily monitoring of suction piping (pre-January1, 1984 not performed (M1) 9 HSC 25292.1 UST system is not operated to prevent unauthorized release, including spills and overfills 10 CCR 2632(c)(2) Monitoring system is not present in the interstitials ace of a double walled UST/piping (M1) 11 CCR 2630(d) UST monitoring equipment is not installed or maintained to detect a leak at the earliest opportunity(mi) 12 HSC 25291(b) UST monitoring system incapable of detecting leak from primary containment into secondary (M1) containment 13 CCR 2636(f)(1) Failed to maintain a continuous monitoring system for underground piping& UDCs that activates (M1) an audible and visual alarm or stops flow of product at the dispenser when it detects a leak 14 CCR 2631 a Primary containment is not product tight 15 HSC 25291(a)(2) Secondary containment for UST system is not tight 16 CCR 2636(c)(1) All releases in secondary piping do not flow to a collection sum 17 CCR 2636(%2) Line leak detectors not installed or failed to detect a 3-gallon per hour leak at 10 psi (M1) 18 CCR 2635(b)(1) Spill container not installed, failed to contain a minimum capacity of five gallons, or failed to (M2) provide a means to keep the spill container emptyf 19 CCR 2635(b)(2) Overfill prevention system was overridden or failed to meet overfill requirements in this section (M2) 20 CCR 2636(a) Failed to have secondaIry containment for piping (includes conventional suction piping) (M2) 21 HSC 25291(e) Water in 21 containment not removed, analyzed & properly disposed of Unauthorized release that: (c)did not escape secondary containment and cleaned up within eight (M1) 22 CCR 2650 hours was not recorded; (e) escaped secondary containment, not cleaned up after eight hours, or a sudden loss of product was not reported to the EHD within 24 hours 23a CCR 2715(a) Failed to inform the EHD of a change of designated operator within 30 days 23b CCR 2715(b) Designated operator did not possess a current ICC UST System Operator certification EHD inspector: Received by: � Titlel; EHD 23-02-002 REV 04/0111110 Page 1 UST OFFICIAL INSPECTION REPORT