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San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, California9520"232 <br />Telephone. (209) 465-3420 Fax: (209) 458-3433 Web. www.siqov.org/ehd <br />�Wtw- <br />Facility Narrie: <br />11 <br />N, <br />C <br />Faci ity A ress: <br />z.7 <br />Pone: <br />Title: <br />nsion Contact: <br />rograrn: <br />Tn-spectionType: <br />CZ <br />- <br />2j <br />Consent Given By: <br />Consent For: <br />Y' Ins 4 action �-x,! Photos <br />I.,5<1 Sam les <br />signated operator: <br />Exp. Date. <br />Technician Onsite <br />Service Tecn <br />Exp. Date: <br />a, <br />on site during inspection <br />❑V <br />CIS <br />101 HSC 25284 <br />No permit to operate <br />V ❑R <br />Ei COS <br />and tank operator to monitor the tank system <br />No written agreement between tank owner a <br />102 HSC 25284(a)(3) <br />V R <br />Ej COS <br />103 HSC 25292.2 <br />Current financial responsibility documents not submitted <br />not submitted or current <br />Permit Application for Facility and Tank information❑V <br />V ❑Ei R <br />❑o COS <br />104 CCR 2711 <br />UST Operating <br />o R <br />❑COS <br />105 HSC 25286(c) <br />Current BOE number not submitted <br />o V o R <br />COS <br />CCR 2632 <br />Monitoring and response plans not current o r approved by the EHD <br />106 <br />monitoring is performed <br />map not submitted or failed to completely show where m <br />E V R <br />COS <br />107 CCR 2632(d)(1)(C) <br />Plot plan/site <br />o V ❑R <br />❑COS <br />108 CCR 2637(f), 2638(e) <br />Failed to notify the EHD 48 hours prior to conducting testing <br />Ei V ❑ R <br />❑ COS <br />log CCR 2637 <br />Failed to test secondary containment <br />0 V D R <br />c COS <br />110 CCR 2637(e) <br />Failed to submit secondary containment test report within 30 days <br />V o R <br />o COS <br />2638(a) <br />Failed to test monitoring and leak detection equipment annually❑ <br />111 CCR <br />❑ V Ei R <br />o COS <br />112 HSC 25284.2 <br />Failed to test spill containers annually <br />❑ V ci R <br />o COS <br />113 CCR 2638(d) <br />Failed to submit monitoring system certification test report within 30 days <br />V Ei R <br />Ei COS <br />Failed to perform 0.1 gph annual line test for pressurized piping without fail safe or shut down <br />0 <br />114 CCR 2636(o <br />of designated operator within 30 days <br />V R <br />■Ei <br />❑o COS <br />115 CCR 2715(a) <br />Failed to inform the EHD of a change <br />V R <br />❑o COS <br />operator, service tech or installer did not possess current ICC certification❑ <br />116 CCR 2715 <br />Designated <br />located within 1000' of a public well❑ <br />V ❑R <br />o COS <br />117 HSC 25292.5 <br />Failed to conduct ELD testing on a system <br />❑V ❑R <br />o COS <br />118 HSC 25292.5 <br />Failed to repair and retest system due to failed ELD test❑ <br />V ❑R <br />o COS <br />119 CCR 2644.1(a)(5) <br />Failed to submit ELD test results within 60 days <br />V ci R <br />c COS <br />years of lining and every 5 years after <br />Failed to inspect a lined or repaired steel tank within 10 yea <br />[3 <br />120 CCR 2663 <br />30 days or to conduct proper tests <br />o V R <br />❑o COS <br />121 1 CCR 2663 <br />Failed to submit tank lining certification within <br />Ei V ❑R <br />o COS <br />122 HSC 25299 <br />Documents were falsified or misrepresented <br />o V o R <br />o COS <br />Permit to repair UST system not obtained <br />123 CCR 2661 <br />❑ V o R <br />o COS <br />CCR 2635(d) <br />Failed to submit UST Certification of Installation/Modification <br />124 <br />Phone: <br />Date: <br />Received by <br />inspector: <br />S e <br />1"209) g <br />(initia <br />