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PUBLIC HEALTH SERVICES SAN JOAQUIN COUNTY <br />ENVIRONMENTAL <br />HEALTH DIVISION <br />304 E. Weber Ave., Third Floor, Stockton, CA 95202 <br />(209) 468-3420 <br />STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br />UNDERGROUND <br />Facility Name <br />Facility Address a Phone No.________ <br />Title <br />Contactpe <br />Facilty <br />f Number of UST(s)�___ a <br />Program BD# --2 3 17f _r-�_----- <br />UST# / Product <br />Mechanical <br />Overfill Prevention: AudiVle <br />and Visual Pressure Suction <br />Piping system: GTv_ <br />Monitoring system No <br />CCR2636 (g): Yes <br />Automatic pump shutdown <br />satisfies <br />VIOLATION(S) <br />facility is not in compliancesection(s) of Health & Safety Code <br />The above <br />(HSC) and/or California Code of Regulations (CCR): <br />1 HSC 25284 <br />Permit to operate <br />Upgrade compliance certificate/sticker <br />2 HSC 25292.3 <br />3 CCR 271 l(b) & (c) <br />Current State Form A & B <br />financial responsibility and letter from chief financial <br />4 HSC 25292.2 <br />Certification of <br />5 CCR 2630 (d) <br />officer <br />Continuous monitoring system for UST system <br />in secondary piping flow to a collection sump <br />6 CCR 2636 (c)(1) <br />CCR 2636 (a) <br />All releases <br />Secondary containment for piping is waterproof <br />7 <br />g CCR 2636 (f)(2) <br />Automatic line leak detector(s) <br />for underground piping <br />9 CCR 2636 (f)(1) <br />Continuous monitoring system <br />Continuous monitoring system for UST <br />10 CCR 2632 (c)(2) <br />11 HSC 25291(a)(2) <br />Secondary containment for UST is tight <br />for dispenser system <br />12 CCR 2636 (f)(1) <br />Continuous monitoring system <br />13 CCR 2635 (b)(1) <br />Spill container <br />14 CCR 2635 (b)(2) <br />Overfill prevention system <br />is product -tight <br />15 CCR 2631 (a) <br />Primary containment <br />UST system is operated to prevent unauthorized release <br />16 HSC 25292.1 <br />17 CCR 2650 <br />Recording/reporting unauthorized release <br />18 CCR 2632 (d) <br />CCR 2712 (i) <br />Monitoring and response plan <br />Monitoring and response plan is on site <br />19 <br />20 CCR 2712 (b) <br />Maintenance and monitoring records <br />21 CCR 2636 (f)(4) <br />Annual line tightness test <br />22 CCR 2630 (d) <br />Annual line leak detector test <br />23 CCR 2630 (d) <br />Annual monitoring certification <br />Daily monitoring of suction piping that is not continuously <br />24 CCR 2643 (d) <br />monitored <br />1 of <br />PHS 260 (8/04/00) <br />