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4 <br />Designated Operator: <br />Facility name: <br />Facility address: <br />Facility ontact: Title: Phone: <br />32,33 <br />g Panel: Piping system: Overfill prevention: <br />0 diblelvisual <br />C I P56�surized El Suction U Gravity techanical Au <br />n type* *onitorine Certification 11 Installation f�lations. "I.Prev El M-3 Bott. <br />11 Other: El m I -RDetect _ <br />WU1 <br />EHD 23-02-002 REV 05/07 <br />Code Section <br />VIOLATION(S) HSC=California Health & Safety Code; CCR=Califomia Code of Rejulations <br />V=Violation; RV=Repeat Violation <br />Permit to onerate <br />KAMM. <br />Secondary containment test performed <br />Certification of financial responsibility and CFO letter <br />MonitorirI is onsite. <br />�Maintcnance & monitorm; records <br />I s%sUtgjMm­jis V ri <br />�.o �erated to 12revent unautbo zed release <br />--- <br />UST monitoring system is resent_ <br />(Mi) <br />a <br />• <br />UST mtern monitoring equipment is operational <br />I Continuous monitoring� systern for underground piping & UDC is present <br />(Mi) <br />rim= contaitmignt is product tight <br />Secondary containment for UST is tight <br />WOM Mtalim <br />All releases in secondary piQLng flow to a collection sump <br />M# <br />Line leak detectTi�' #. <br />(Mi) <br />container <br />—spill <br />Overfil�g�i n jMtem(M2)_MM <br />Conventional suction piping shall have continuous monito�n <br />MM <br />Water in 2' containment analyzed & RE2Rerly dispas�of <br />MM <br />--MM <br />Recordin6rel o in unauthorized releases <br />(Mi) <br />�of <br />• <br />Annual moertiCication <br />MM <br />I IiIII M -e <br />Annual- line leak detector test <br />(Mi) MM <br />Annual spill containment testing <br />MM <br />Annu <br />(Mi) MM <br />Kole]. <br />�2air for tan Jpj&�bad iglitness test <br />(M2) <br />Biennial tightness test of gravity piping (pre -January 1, 1984) <br />!rill I M, <br />EM, I 10 ul WA I k ke a"7111 <br />Permit to Mair UST system <br />Pen -nit to alter monitoring system <br />Permit to_temp <br />Permit to close UST systern <br />Disabling leak detection devices <br />HSC 25298 a) <br />Illegal abandonment of U <br />R <br />P <br />IIIP 0I i <br />UIC <br />Sotic system: <br />7 Serves �:20 people/day <br />-I Receives other than sanitary waste <br />Other disposal methods: <br />7j Ehy Ivells/French Drains <br />WU1 <br />EHD 23-02-002 REV 05/07 <br />