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M <br /> 0 SAN JOAQUIN COUNTY 0 <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 /> Date- <br /> Lkr <br /> 11VOTity address: UST# C^, <br /> �f7,, Product <br /> Facility Contact: a 'title: Phone: <br /> nitoring Panel: Piping system: Overfill prevention: <br /> V"4.' OCL Spoo >4ressurized ❑Suction ❑Gravity echanical ❑Audible/visual <br /> Inspection type: Violations: <br /> Routine onitoring Certification ❑Installation ❑Other: 1-RDetect ❑M2-RPrev ❑M-3 Both <br /> VIOLATION(S) HSC=California Health&Safety Code;CCR=California Code of Regulations V R <br /> # Code Section V <br /> V=Violation; RV=Re eat Violation <br /> 1 HSC 25284 Permit tooperate <br /> 2 CCR 2637 Secondary containment test performed <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 X <br /> 5 CCR 2632 b Monitoring Program(Monitoring&Response Plan is current and approved by the local agency. <br /> 6 CCR 2712 i Monitoring Ian is onsite. <br /> 7 CCR 2712 b Maintenance&monitoring records (M1) <br /> 8 CCR 2643 d Daily monitoring 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 1 Continuous monitorings stem for underground piping&UDC is present M1) <br /> 14 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 pipingflow 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 CCR 2635(b)(2) Overfill prevention system (M2) <br /> 20 CCR 2636(a) Conventional suction piping shall have continuous monitoring&20 containment <br /> 21 HSG 25291 (e) Water in 20 containment analyzed&properly disposed of <br /> 22 CCR 2650 Recording/reporting of unauthorized releases (M1) <br /> 23 CCR 2715Desi nated Operator: a Statement from UST owner; c-e Monthl ins ectlo Em to ee ral <br /> 24 CCR 2638 a Annual monitoringcertification <br /> 25 CCR 2638 2 Annual line leak detector test (M1) <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636 4 Annual line tightness test (M1) <br /> 28 CCR 2661 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 INSPEC PHONE: UIC <br /> Septic system: <br /> ❑Serves>_20 people/day <br /> RECEI TITLE: ❑Receives other than sanitary waste <br /> 7Other disposal methods: <br /> [1 Dry wells/French Drains <br /> EHD 2 2: 02 REV 8/08 UST INSPECTION FINAL <br />