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y/ SAN JOAQUIN COUNTY <br /> 4K (f SAN <br /> HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3`d Floor,Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sj og v.or /Q ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> Facility address: UST# <br /> t.�./ Product ! � <br /> Facility Contact: Title: Phone: <br /> Monitoring Panel: Piping system: Overfill prevention: <br /> ,AJC el 4 75- 1001 ❑"Pressurized ❑Suction ❑Gravity ❑Mechanical ❑Audible/visual <br /> Inspection type: Violations: <br /> 04(51-'tine ❑Monitoring Certification ❑Installation ❑Other: ❑M1-RDetect ❑M2-RPrev ❑M-3 Both <br /> VIOLATION(S) HSC=California Health&Safety Code;CCR=California Code of Regulations V R <br /> # Code Section V <br /> V=Violation;RV=Re eat Violation <br /> 1 HSC 25284 Permit tooperate <br /> 2 CCR 2637 Secondary contaitnt tent test, onned <br /> 3 CCR 2711 & c Current Unified Program Consolidated Forms on file with EHD(Facility and tank form <br /> 4 . ,. 25292.2 Certification of financial responsibility and CFO letter <br /> 5 CCR 2632 c 2 D Monitoring&response plan is current and filed with the local agency <br /> 6 CC .2712 i, <br /> *pitoring&response plan is onsite <br /> 7 CCR 2712 Maintenance&monitoring records Mi <br /> 2tw43 d mail monitorin of suction piping(pre-January,1,19$4 <br /> 9 HSC 25292.1 UST s stem isoperated to prevent unauthorized release <br /> 2632.,e 2' UST monitoring system is present (Mil <br /> 11 CCR 2.630 d UST system monitoring equipment is properly located to detect a leak. MI <br /> 11° HS '2Z , " 'IJP tem monitoringequipment is operational M2) <br /> 13 CCR 2636 1 Continuous monitoring system for underground piping&UDC is present (MI) <br /> F ;14 y containment is pproduct tight 'f <br /> 15 HSC 25291 a 2 Secondary containment for UST is tight <br /> BCi 2631 c All releases in sero piping flow to a collection"tui <br /> 17 HSG 25291 Line leak detectors are installed Mi <br /> i. .l8 CGR26 5 1: V Sill container w) <br /> 19 CCR 2635(b)(2) Overfill prevention system M2 <br /> 2Q X36(a) Conventional suction piping shall have continuous &2°containment <br /> 21 HSC 25291 (e) Water in 2°containment analyzed&pro erl disposed of <br /> v 2• cm, .: Recopitt ofunauthorized'releasea <br /> 23 CCR 2715 DesignatedOperator: a Statement from UST owner; (a,,e)Monthly inspection;(9 Em to ee training <br /> CCR 2638 a monitoring certification <br /> 25 CCR 2638(a) Annual line leak detector test Ml <br /> " <br /> HSC 2$284.2 AnhI i 1 containment testing <br /> 27 CCR 2636 4 Annual line ti htness test I <br /> 3fi6I•. R. "-:fortank/pip <br /> ing has had tightness test' <br /> 29 CCR.2643 a Biennial tightness test of gravity piping(pre-January 1, 1984 <br /> 3Sl CCR 2643 d. Trietttiial line test for conventional suction piping y. <br /> t l 84 �h <br /> 31 HSC 25292.5 Double walls stem located within 1000'of public well-ELD <br /> 32 CCR 2661 Pemltit to repair UST system <br /> 33 HSC 25286(a) Permit to alter monitoring system <br /> 34 HSC 25298 Permit to temporarily close UST system <br /> 35 HSC 25298 c Permit to close UST system <br /> 36 HSC 25299 a 9 Disoying' leak detection devices <br /> 37 HSC 25298 a Illegal abandonment of UST system <br /> 38 Other: <br /> EHD INSPECTOR- PHONE: UIC <br /> G z Q/ S--" Septic system: <br /> O ❑Serves>_20 people/day <br /> RE ED BY: E!TITLE^ Receives other than sanitary waste <br /> Other disposal methods: <br /> ❑Dry wells/French Drains <br /> EHD 23-02--002 / <br />