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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 East Weber Avenue, P Floor, Stockton, CA 95202-2708 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.si og v.org/ehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br />Facility name: <br />Q <br />Designated Operator: <br />Inspection Date: <br />Facility address: <br />UST # <br />Product <br />Facility Contact: <br />Title: Phone: <br />M <br />itoring Panel: <br />Pip' g system: <br />l`SPressurized 11 Suction ❑ GravityLV <br />OOv rfill prevention: <br />Mechanical ❑Audible/visual <br />ection type: <br />Routine onitorin <br />Certification ❑ Installation ❑ Other: <br />Violations: <br />❑ M1-RDetect ❑ M2-RPrev ❑ M-3 Both <br /># <br />Code Section <br />VIOLATIONS) HSC=Califomia Health & Safety Code; CCR=Califomia Code of Regulations V R 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 />1 HSC 25292.2 <br />Certification of financial responsibility and CFO letter <br />5 <br />CCR 2632 c 2 D <br />Monitoring & response plan is current and filed with the local agency <br />6 <br />CCR 2712 i <br />Monitoring & response plan is onsite <br />7 <br />CCR 2712 b <br />Maintenance & monitorin records Ml <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 monitorin system is present MI <br />11 <br />CCR 2630 d <br />UST system monitoring equipment is properly located to detect a leak Ml <br />12 <br />HSC 25291 <br />UST system monitoring equipment iso rational M2 <br />13 <br />CCR 2636 1 <br />Continuous monitoring system for underground piping & UDC is present Ml <br />14 <br />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 sump <br />17 <br />HSC 25291 <br />Line leak detectors are installed Ml <br />18 <br />CCR 2635 (b)(1) <br />Spill container M2 <br />19 <br />CCR 2635 (b)(2) <br />Overfill prevention system M2 <br />20 <br />CCR 2636-(a) <br />Conventional suction 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 MI <br />23 <br />1 CCR 2715 <br />Designated Operator: (a) Statement from UST owner; (c -e) Monthly inspection; Employee training <br />24 <br />CCR 2638 a <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 testin <br />27 <br />CCR 2636 4 <br />Annual line tightness test M1 <br />28 <br />CCR 2661 <br />Repair for tank/piping has had ti mess test M2 <br />29 <br />CCR 2643 a <br />Biennial tightness test ofgravity piping (pre -January 1, 1984 <br />30 <br />CCR 2643 d <br />Triennial line test for conventional suction piping (pre-January1, 1984 (M1 <br />31 <br />HSC 25292.5 <br />Double walls stem located within 1000' ofpublic well-ELD <br />32 <br />" CCR 2661 <br />Permit to repair UST system Jr, <br />33 <br />HSC 25286 a <br />Permit to alter monitoring system <br />34 <br />HSC 25298 ) '' <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 />HSC 25298 a) <br />Illegal abandonment of UST system <br />38 <br />Other: <br />EHD INSPECTOR: <br />PHONE: <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 />RECEIV Y: <br />TITLE: <br />V <br />EHD 23-02-002 <br />I <br />