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SAN JOAQUIN COUNTY *NVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, California 95202-3029 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sJgov.or&hd lITNnWl2CVniTNn cTnRAGR TANK (ITSTI PROGRAM INSPECTION REPORT Facility n Designated Operator: Inspection Date: Facility address: IQ UST # 'IV �� CA Product 1� Facility Co act: Title: Phone: - Monitoring Panel:Piping system: Overrill prevention: ❑ Pressurized uction ❑ Gravity ❑ Mechanical udible/visual Inspection type: outine onitorin Violations: Certification ❑ Installation ❑ Other: ❑ M1-RDetect ❑ M2-RPrev ❑ M-3 Both # Code Section VIOLATIONS) HSC=California Health & Safety Code; CCR=California Code of Regulations V=Violation; RV=R eat Violation V R V 1 HSC 25284 Permit to operate 2 CCR 2637 Secondary containment test performed 3 CCR 2711 b & c Current Unified Program Consolidated Forms on file with EHD(Facility and tank form 4 HSC 25292.2 Certification of financial responsibility and CFO letter 5 CCR 2632 b Monitoring Program(Monitoring & Response Planis current and approved by the local agency. 6 CCR 2712 i) Monitoring plan is onsite. 7 CCR 2712 b Maintenance & monitoring records MI 8 CCR 2643 d) Daily monitoring of suction piping (pre -January, 1, 1984) 9 HSC 25292.1 UST system isoperated to prevent unauthorized release 10 CCR 2632 (c)(2) UST monitoring system is present 1 11 CCR 2630 d UST system monitoring equipment is properly located to detect a leak Ml 12 HSC 25291 ) UST system monitoring equipment isoperational M2) 13 CCR 2636 1 Continuous monitoring system for underground piping & UDC is present M1 14 CCR 2631 a) 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 Line leak detector(s) are installed M1 18 CCR 2635 (b)(1) Spill container M2) 19 CCR 2635 (b)(2) Overfill prevention system M2 20 CCR 2636 (a) Conventional suction piping shall have continuous monitoring & 2° containment 21 HSC 25291 (e) Water in 2° containment analyzed & properly disposed of 22 CCR 2650 Recording/reporting of unauthorized releases Ml 23 CCR 2715 DesignatedOperator: (a) Statement from UST owner; (c -e) Monthly inspection; (f) Employee training 24 CCR 2638 a Annual monitoring certification lid 25 CCR 2638 a) Annual line leak detector test (M1) 26 HSC 25284.2 Annuals ill containment testing 27 CCR 2636 (f)(4) Annual line tightness test Ml 28 1 CCR 2661 f) Repair for tank/piping has had tightness test (M2) 29 CCR 2643 a Biennial tightness test of gravity pipingre-Janus 1, 1984 30 CCR 2643 d) Triennial line test for conventional suction piping (pre-January1, 1984) (Ml) 31 HSC 25292.5 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) Disabling leak detection devices 37 HSC 25298 a) Illegal abandonment of UST system 3t Other: E JN E O ONE: q UIC �� / 61 Septic system: ❑ Serves >_20 people/day ITLE: ❑ Receives other than sanitary waste Other disposal methods: M 11 F1 Dry wells/French Drains IWECEI BY: EHD 23-02-002 REV 05/07