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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, California 95202-3029 Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: www.sigov.org/ehd UNDERGROUND STORAGE TANK (USTI PROGRAM INSPECTION REPORT Facility name: A/qr`� Designated Operator: (OPP ^ Inspection Date: —W Facility address: / UST # -Product Facility Contact: Title: Phone: 6 frt q 0- ji L MoWtoring Panel -Piping S �v system: KPressurized ❑ Suction ❑ Gravity Overfill prevention: 14 Mechanical ❑ Audible/visual Inspection type: Routine gMonitoring Certification ❑ Installation ❑ Other: Violations: ❑ M1-RDetect M2-RPrev ❑ M-3 Both # Code Section VIOLATION(S) HSC=California Health & Safety Code; CCR=California Code of Regulations V R V=Violation; RV=Re eat Violation V 1 HSC 25284 Permit tooperate 2 CCR 2637 Secondary containment test performed to -23-01 3 CCR 2711 b & c Current Unified Program Consolidated Forms on file with EHD Facilit and tank for 4 HSC 25292.2 Certification of financial responsibility and CFO letter 5 CCR 2632 b Monitoring Program (Monitodng & Response Plan is current and approved by the local agency. 6 CCR 2712 i Monitoring Ian is onsite. 7 8 CCR 2712 b CCR 2643 d Maintenance & monitoring records M1) Daily monitoring of suction piping (pre -January, 1, 1984 9 HSC 25292.1 UST system isoperated to prevent unauthorized release 10 11 • 12, CCR 2632 (c)(2) CCR 2630 d HSC 25291 b UST monitorings stem is present (M1) UST system monitoring equipment is properly located to detect a leak M1) UST system monitoring equipment is operational (M1) 13 14 CCR 2636 (f)(1) CCR 2631 a Continuous monitorings stem for underground piping & UDC is present (M1) Primary containment is product tight 15 HSC 25291 (a)(2) Secondary containment for UST is tight 16 CCR 2636 (c)(1) All releases in secondary piping flow to a collection sum 17 HSC 25291 f Line leak detectors are installed (M1) 18 19 20 CCR 2635 (b)(1) CCR 2635 (b)(2) CCR 2636 (a) Spill container (M2) y� Overfill Prevention system 11112) Conventional suction piping shall have continuous monitoring & 20 containment 21 . HSC 25291 (e) Water in 20 containment analyzed & properly disposed of 22 23 CCR 2650 CCR 2715 Recording/reporting of unauthorized releases M1) Designated Operator: a Statement from UST owner; (c -e) Monthly inspection; Employee training 24 CCR 2638 a Annual monitoring certification 7- -o 25 CCR 2638 a Annual line leak detector test M1 26 HSC 25284.2 Annuals ill containment testing 27 CCR 2636 4 Annual line tightness test M1 28 29 CCR 2661 CCR 2643 a Repair for tank/piping has had tightness test (M2) Biennial tightness test of gravity piping(pre-January 1, 1984 30 31 CCR 2643 d 1 HSC 25292.5 Triennial line test for conventional suction piping (pre -January 1, 1984) (M1) Double walls stem located within 1000' of public well-ELD 32 CCR 2661 Permit to repair UST system 33 HSC 25286 a Permit to alter monitoring system 34 HSC 25298 b Permit to temporarily close UST system 35 HSC 25298 c Permit to close UST system 36 HSC 25299 a 9 2 Disabling leak detection devices 37 HSC 25298 a Illegal abandonment of UST system 38 Other: EHD INSP CTOR: q a PHONE: _ D UIC �i Septic system: ❑ Serves >_20 people/day TITLE:/ ❑ Receives other than sanitary waste YOther disposal methods: ❑ Dry wells/French Drains RECEIVED BY: EHD 23-02-002 REV 8/08