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SAN J A UIN COUNTY <br /> o <br /> <l ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> UNDERGROUND STORAG TAN (UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> 1/ Uar C a <br /> FaCill ad rens: UST# <br /> Product <br /> Fac'ity Contact: Title: Phone: <br /> ups w ✓ ® 3 qs' �, <br /> nitoring Panel: Piping system Overfill prevention: <br /> rLh �51 Pressurized ❑Suction ❑Gravity Mechanical ❑Audible/visual <br /> Inspection type: Violations: <br /> outine monitoring Certification ❑Installation ❑Other: I XMI-RDetect ❑M2-RPrev ❑M-3 j3oth <br /> VI LATI (S) HSC=Califomia Health&Safety Code;CCR=California Code of Regulations V <br /> # Code Section V <br /> V=Violation;RV=Re eat Violation <br /> 1 HSC 25284 Permit tooperate <br /> 2 CCR 2637 Seconder containment test erformed <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(c)(2)(D) MonitorinE&response 21an is current and filed with the local agency <br /> 6 CCR 2712 i Monitoring&response plan is onsite <br /> 7 CCR 2712 b Maintenance&monitoring records Ml <br /> 8 CCR 2643 d Daily monitoring of suction pi2ing(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 Ml <br /> 11 CCR 2630(d) UST system monitoring equipment is pro erly located to detect a leak MI <br /> 12 HSC 25291 (b) UST system monitorin a ui ment iso erational M2 <br /> 13 CCR 2636(f)(1) Continuous monitorin s stem for under ound i in &UDC is present Ml <br /> 14 CCR 2631 a PriM containment is j2roduct tight <br /> 15 HSC 25291 (a)(2) Secondary containment for UST is tight <br /> 16 CCR 2636 c 1 All releases in seconda piping flow to a collection sum <br /> 17 HSC 25291 (D Line leak detector(s)are installed MI <br /> 18 CCR 2635 1 S ill container M2 <br /> 19 CCR 2635(b) 2 Overfill revention s stem ( 2) <br /> 20 CCR 2636(a) Conventional suction piping shall have continuous monitoring&2°containment <br /> 21 HSC 25291 (e) Water in 21 containment analyzed&2roperly disposed of <br /> 22 CCR 2650 Recording/re2ortinE of unauthorized releases Ml <br /> 23 CCR 2715 Designated Operator:(a)Statement from UST owner; (c-e)Monthly inspection;(f)Employee training <br /> 24 CCR 2638 a Annual monitoring certification <br /> 25 CCR 2638(a Annual line leak detector test (Ml) <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636(f)(4) Annual line tightness test (MI) <br /> 28 CCR 2661 Repair for tank/piping has had ti htness test M2 <br /> 29 CCR 2643(e) Biennial tightness test of gravity piping( re-Januar 1, 1984) <br /> 30 CCR 2643 d Triennial line test for conventional suction i in re-Jams 1, 1984) Ml <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 a)(9) Disabling leak detection devices <br /> 37 HSC 25298 a) Illegal abandonment of UST system <br /> 38 Other: <br /> E INSPECTOR: P ONE: UIC <br /> �ry Septic system: <br /> ❑Serves>_20 people/day <br /> RECEIVED B TITLE: ❑Receives other than sanitary waste <br /> Other disposal methods: <br /> ❑D wells/French Drains <br /> EHD 2302 <br /> 1/3/07 <br />