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SAN JOAQi;IN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, California 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.or <br />UNDERGROUND STORAGE. TANK fITfiTI PRtilf RAM 1[NCPRCTIrnN RTPnWr <br />Facility name: <br />s 3c CC)fp,VAf b , <br />es i ated Operator: Inspection ate: <br />(�;��AP� 1 3 2� �� <br />T,1 t, e il.� e x 17 ��I1 <br />Facility address: <br />UST # <br />Product <br />Facility Contlict: Title: Phone: <br />n Panel• <br />ftCTC � 3 <br />Piping system: <br />YPres,wized ❑ Suction ❑ Gravity <br />Overfill prevention: <br />echanical ❑ Audible/visual <br />Inspection type: <br />Routine VMonitoring <br />Certification ❑ Installation ❑ Other: <br />Violations: <br />❑ MI-RDetect ❑ M2-RPrev M-3 Both <br /># Code Section <br />VIOLATION(S) HSC=California Health & Safety Code; CCR=California Code of Regulations V R <br />V=Violation; RV=Rcpeat Violation V <br />I I HSC 25284 <br />Permit tooperate <br />2 1 CCR 2637 <br />Secondary containment test performed <br />3 CCR 2711 b) & c <br />Current Unified Program Consolidated Forms on file with EHD(Facility and tank form <br />4 HSC 25292.2 <br />Certification of financial responsibility and CFO letter <br />5 CCR 2632 b <br />Monitoring Pro(Monitoring & Response Plan is current and approved by the local agency. <br />6 CCR 2712 i <br />Monitoring Ian is onsite. <br />7 CCR 2712 b <br />Maintenance & monitoring records M1 <br />8 1 CCR 2643 d) <br />Daily monitoring of suction piping (pre -January, 1, 1984 <br />9 HSC 25292.1 <br />UST system isoperated to prevent unauthorized release <br />10 CCR 2632 (c)(2) <br />UST monitoring system is present (Mi) <br />l CCR 2630 d <br />UST system monito ring equipment is properly located to detect a leak (M1 <br />12 HSC 25291 b <br />UST system monitoring equipment isoperational (M2 <br />13 CCR 2636 1 <br />Continuous monitoring system for underground piping & UDC is present M1 <br />14 CCR 2631 a <br />Primary containment is product tight <br />15 HSC 25291 (a)(2) <br />Secondary containment for UST is tight <br />16 CCR 2636 (c)(1) <br />All releases in secondary pipingflow to a collection sum <br />17 HSC 25,291 <br />Line leak detectors are installed M1) <br />18 CCR 2635 (b)(1) <br />Spill container M2) <br />19 CCR 2635 b <br />Overfill grevention system(M2) <br />20 CCR 2636 (a)'' <br />Conventional suction piping shall have continuous monitoring &'2* containment <br />21 HSC 25291 (e) <br />Water in 20 containment analyzed & properly disposed of <br />22 CCR 2650 <br />Recording/reporting of unauthorized releases M1 <br />23 CCR 2715 <br />DesignatedOperator: a) Statement from UST owner; (c -e) Monthly inspection; Employee training <br />24 CCR 2638 a <br />Annual monitoring certification <br />25 CCR 2638 a) <br />Annual line leak detector test (M1) <br />26 HSC 25284.2 <br />Annuals ill containment testing <br />27 CCR 2636 4 <br />Annual line tightness test M1 <br />28 CCR 2661 <br />Repair for tank/piping has had tightness test (N12), <br />29 CCR 2643 a <br />Biennial tightness test of gravity pipingre-Janus 1, 1984 <br />30 CCR 2643 d) <br />Triennial line test for conventional suction piping (re -Janus 1, 1984) (M1 <br />31 HSC 25292.5 <br />Double walls stem located within 1000' of pub4 well-ELD <br />32 CCR 2661 <br />Permit to repair UST system <br />33 HSC 25286 a <br />Permit to alter monitoring system <br />34 HSC 25298 b) <br />Permit to temporarily close UST system <br />35 HSC 25298 c <br />Permit to close UST system <br />36 HSC 25299 (a)(9) <br />Disabling leak detection devices <br />37 HSC 25298 a <br />Illegal abandonment of UST system <br />38 1 Other: <br />EHD SPECTOR: +' <br />PHONE: <br />UIC <br />S tr tem: <br />= Sery0 people/day <br />- Receives er than sanitary waste <br />Other disposal me s: <br />Dry wells/French ins <br />RECEIVED B <br />TITLE: <br />(J�7 <br />u <br />EHD 23-02-002 REV 05/07 <br />