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03129/2005 14:24 2094683433 FIFTH FLOOR PAGE 02 <br /> l0 <br /> SAN JOAQUIN COUNTY 0 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3`d Floor,Stockton,CA 95202-2708 <br /> Telephone.(209)468-3420 Fax:(209)468-3433 Web:www.sigov.otg/ehd <br /> UNDERGROUND STORAGE 'TANK(USD PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> Facility address: UST#t <br /> 0 Product ` 1 <br /> Facility Contact! Title: Phones <br /> 157)"?,djob <br /> ATIlorins Panel: Pi ing system: verfill prevention: <br /> ✓r-S �S6 ressurimd 0 Suction ED GraviT A <br /> y Mechanical ❑Audibic/vigual <br /> Inspection type: violations: <br /> outinc "nitoring Certification 0 installation ❑Other; ❑Mi-RDetect 13M2-RPrev ❑M-3 Both <br /> Code_Section A _ HSC=California Health&SafeZy Code;CCR=California Code of Regurtions-- <br /> V=Violation;RV=Rc cat Violation V <br /> 1 HSC 25264 Permit too erate <br /> .;CCR 26r. ' 'Sccoindiirycobtainment test:cdormed <br /> 3 CCR 2711 & c Current Unified Program Consolidated Forms on file with EHD ffacilirX and tank form <br /> 4 HS:C 25292.2 :' Certification of financial re ansibili ' and.CFO tetter. . . <br /> 5 CCR 2632 e 2 D Monitoring&response plan is current and filed with the local a enc <br /> 6 CCR 2712i monitoring&iek2nsej2lari is onsite <br /> 7 CCR 2712 Maintenance&monitoring records NI1 <br /> 8:;' CCR 2643(d): Dail monitonri 'of suction i in¢: e-Janu j. 19841': <br /> .. <br /> 9 HSC 25292,1 UST astern is o rated to prevent unauthorized release <br /> 0 CCR 263:2(c)Q). UST monitorin stem is. t . . 1171 <br /> 11 CCR 2630 d UST system monitoring c u ment is properly located to detect a leak MI <br /> '11,- ',:HSC 25-29YL, UST.'s stem.monitorin ui ment'is o eraiionhl 2 .: <br /> 13 CCR 2636 1 Continuous monitoring tem for under ound Eiping&UDC is present <br /> :74..: '.-CCR 2631 a Plrir&r containment is oduct ti lit <br /> 15 HSC 25291 (a(2) Secondary containment for UST is right <br /> 16,; CCR,2636 <br /> _(t)(l) ;° All releases in secondary 2ipingflaw to a collection su <br /> 17 HSC 25291 Line leak detector(s)are installed Z <br /> 48 CCR:2635. b Y S. ill container {lk[2. <br /> 19 CCR 2635 2 Overfill rcvcntion systcm N1Z <br /> 20:;; . ,CCR2636.a <br /> : Conventional suction to shad have.bonrinuous monttonn &2°contain'ment.: <br /> 21 HSC 25291 (c) Water in 2°containment anal zed&pToperlX disposed of <br /> 122:.. : CCR.2650. :RecoTdin re ottin of:uhatithorized.rcicases ": .MI <br /> 23 CCR 2715 Designated Operator., a)Statement from UST owner, (c-e)Monthly inspection;( Employee trainin <br /> 1.24.;::'.i :CCR.2638:a. ,: .. i <br /> . Annual monitoring-certification .: • <br /> 25 CCR 2638 a Annual line leak detector test ED <br /> 26':::.:;:.:HS'C:�25254 2., ,. Annual:spill containment testis <br /> 27 CCR 2636 4 Annual line tightness test 1 <br /> ,:28 CCR 2661 ( : . :. . . ltb' air for tank/ i in '•has had ti Lbtncss test INZ <br /> 29 CCR 2643 a Biennial tightness test of gravity pipingre-Januar 1, 1984 <br /> !CCR;2643 d Triennial line'testf6r.conventtonalsucdon pipiz( . -Jana 1, 1984 MI. <br /> 31 HSC 25292.5 Doublc wall sstem located within 1000'of gublic well-ELI <br /> 51. CCR.2661: Permit to rqajr,USTsysterrt „ .. <br /> 33 HSC 25286 a Permit to alter monitoring system <br /> 34 HSC 25298 Permit to temporarily close UST system <br /> 35 HSC 25298 c Permit to close UST system <br /> 36:: HSC 25299(a)(9) Disabl:in .leak detection devices <br /> 37 HSC 25298 a 1115 al abandonment of UST systcm <br /> 39 Other: <br /> EHDINSPE TOR PHONE: ' u1C <br /> septi c system: <br /> 1744-1) Li Serves 220 peoplt/day <br /> RE EIVED BY: PITLE: u Rzccives other than'mnitary waste <br /> .r .4+p1 Other diaosai methods: <br /> ❑Dry wells/French Drains <br /> E14D 23.02.002 <br />