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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.ort?/ehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br />Facility name: <br />Designated Operator <br />Inspection Date: <br />Facility address: <br />UST # <br />Product <br />t' <br />7 <br />Facility Contact: <br />boo C-)1'' Y LC t.i <br />Title: Phone: <br />C -iv V' f�, QG t + (l �^". � 1>3c m Gq Co i <br />, <br />' <br />Monitoring Panel: <br />Piping system: <br />I pressurized ❑ Suction ❑ Gravity <br />Overfill prevention: <br />"echanical ❑ Audible/visual <br />Inspection type: <br />l4outine U/m.itorin Certification ❑ Installation ❑ Other: <br />Violations: <br />❑ M1-RDetect ❑ M2-RPrev " El M-3 Both <br /># <br />Code Section <br />VIOLATION(S),HSC=California Health & Safety Code; CCR=California Code of Regulations V R <br />V=Violation; RV=Re eat Violation V <br />1 <br />HSC 25284 <br />Permit tooperate <br />2 <br />CCR 2637 <br />Secondary containment test performed <br />3 <br />CCR 2711 b & c <br />Current Unified Program Consolidated Forms on file with EHD(Facility and tank form <br />4 <br />HSC 25292.2 <br />Certification of financial responsibility and CFO letter <br />5 <br />CCR 2632 b <br />Monitoring Program(Monitoring & Response Plan is current and approved by the local agency. <br />6 <br />CCR 2712 i) <br />Monitoring Ian is onsite. <br />7 <br />CCR 2712 b <br />Maintenance & monitoring records M1 <br />8 <br />CCR 2643 d <br />Daily monitoring of suction piping (pre -January, 1, 1984) <br />9 <br />HSC 25292.1 <br />UST system isoperated to prevent unauthorized release <br />10 <br />CCR 2632 c)(2) <br />UST monitoring system is present (M1) <br />11 <br />CCR 2630 d <br />UST system monitoring equipment is properly located to detect a leak M1) <br />12 <br />HSC 25291 b <br />UST system monitoring equipment isoperational (M2 <br />13 <br />CCR 2636 1 <br />Continuous monitoring system for underground piping & UDC is present M1 <br />14 <br />1 CCR 2631 a <br />Primary containment is product tight <br />15 <br />HSC 25291 (a)(2) <br />Secondary containment for UST is tight <br />16 <br />CCR 2636 (c)(1) <br />All releases in secondary pipingflow to a collection sum <br />17 <br />HSC 25291 <br />Line leak detectors are installed M1 <br />18 <br />CCR 2635 (b)(1) <br />Spill container (M2) <br />19 <br />CCR <br />M2)f <br />20 <br />1 CCR (a) <br />tWaflctjn piping shall have continuous monitorin & 2° containment <br />21 <br />HSC 25291 (e) <br />Water in 2° containment analyzed & properly disposed of <br />22 <br />CCR 2650 <br />Recording/ reporting of unauthorized releases (M1) <br />23 <br />CCR 2715 <br />DesignatedOperator: (a) Statement from UST owner; (c -e) Monthly inspection; Employee training <br />24 <br />CCR 2638 a - <br />- . . <br />'Annual monitoring certification <br />25 <br />CCR 2638 a) <br />Annual line leak detector test (M1) <br />26, <br />HSC 25284.2 <br />Annuals ill containment testing <br />27 <br />CCR 2636 4 <br />Annual line tightness test (M1) <br />28 <br />CCR 2661 <br />Repair for tank/piping has had tightness test (N12) <br />29 <br />CCR 2643 a <br />Biennial tightness test of gravity pipingre-Jams 1, 1984 <br />30 <br />CCR 2643 d) <br />Triennial line test for conventional suction piping (re -Janus 1, 1984) (M1) <br />31 <br />HSC 25292.5 <br />Double walls stem located within 1000' of public well-ELD <br />32 <br />CCR 2661 <br />Permit to repair UST system <br />33 <br />HSC 25286 a <br />Permit to alter monitoring system <br />34 <br />HSC 25298 b) <br />Permit to temporarily close UST system <br />35 <br />HSC 25298 c) <br />Permit to close UST system <br />36 <br />HSC 25299 (a)(9) <br />Disabling leak detection devices <br />37 <br />1 HSC 25298 a <br />Illegal abandonment of UST system <br />38 <br />1 Other: <br />EHD INSPECTOR: <br />A <br />PHONE: <br />Q1 <br />UIC <br />Septic system: <br />Serves >_20 people/day <br />-Receives other than sanitary waste <br />Other disposal methods: <br />—Dry wells/French Drains <br />J <br />RECEIVED BY:TITLE: <br />Z-1 ""4 4 <br />% <br />%f)L / "�?YLIr� i dw <br />EHD 23-02-002 REV 05/07 <br />