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SAN JOAQUIN COUNTY DATE <br />PR# <br />VIRONMENTAL HEALTH DEPAR1*NT PAGE <br />*E. Weber Ave., Third Floor, Stockton, CA 95202 <br />(209) 468-3420 <br />UNDERGROUND STORAGE TANK (UST)_ PROGRAM INSPECTION REPORT <br />Facility Name �� .c_ Facility Address b ?- <br />Facilty Contac G s i�/!�+✓fitle kAd Phone #� <br />UST# -1 Product UST# Product UST#_Product UST# Product <br />Overfill Prevention: �eNisual ❑Mec anical Monitoring VIA <br />x <br />Piping System: El Gravity [I Pressure Suction Violations: ❑ M1-RDet ❑ M2-Rprev ❑ M3 -Both <br />Automatic Pump Shut Down Satisfies CCR 2636 (f)(5): ❑ Yes iiNo Designated Operator: <br />INSPECTION TYPE: ❑Routine ❑Monitoring Certification ❑Complaint ❑Install ❑Removal ❑Repair/Upgrade <br />COMPANY NAME: <br />TECHNICIAN NAME: <br />PHONE: <br />VIOLATION(S) <br />The above facility is not in compliance with the following section(s) of Health & Safety Code (HSC) and/or <br />California Code of Regulations (CCR): <br />1 HSC 25284 <br />2 CCR 2637 <br />3 CCR 2711(b) & (c) <br />4 HSC 25292.2 <br />5 CCR 2632 (c)(2) <br />6 CCR 2630 (d) <br />CCR 2637(b) <br />8 CCR 2636 (f)(1) <br />9 CCR 2636 (c)(1) <br />10 <br />HSC 25291 (f) <br />11 <br />HSC 25291(a)(2) <br />12 <br />CCR 2635 (b)(1) <br />13 <br />HSC 25284.2 <br />14 <br />CCR 2635 (b)(2) <br />15 <br />CCR 2631 (a) <br />16 CCR 2632 (d) <br />17 CCR 2712 (i) <br />18 CCR 2712 (b) <br />19 CCR 2636 (f)(4) <br />20 CCR 2630 (d) <br />21 CCR 2630 (d) <br />22 CCR 2661 (f) <br />Permit to operate <br />Secondary cont. testing <br />Current State Forms A & B <br />Certification of financial <br />responsibility & CFO letter <br />UST monitoring is present (M1) <br />UST system monitoring <br />equipment is properly located to <br />detect a leak (M1) <br />UST system monitoring <br />equipment is operational (M1) <br />Continuous monitoring system <br />for underground piping & UDC <br />is present (M1) <br />All releases in secondary piping <br />flow to a collection sump <br />Line leak detector(s) (M1) <br />Secondary containment for <br />UST is tight <br />Spill container (M2) <br />Annual spill container testing <br />Overfill prevention system (M2) <br />Primary containment is product <br />tight <br />Monitoring & response plan <br />Monitoring & response plan is <br />on site <br />Maintenance & monitoring <br />records (M1) <br />Annual line tightness test <br />Annual line leak detector test <br />(M1) <br />Annual monitoring certification <br />Repair for tank/piping has had <br />tightness test (M2) <br />23 <br />CCR 2643 (d) <br />Daily monitoring of suction <br />piping (pre -1/1/84) <br />'24 <br />CCR 2636 (a) <br />Conventional suction piping <br />shall have continuous <br />monitoring & 20 containment <br />25 <br />CCR 2643 (e) <br />Biennial tightness test of gravit% <br />piping (pre -1/1/84) <br />26 <br />CCR 26.43 (d) <br />Triennial line test for <br />conventional suction (pre - <br />1/1/84) (M1) <br />27�CCR 2661 <br />Permit to repair UST system <br />28 <br />HSC 25286 (a) <br />Permit to alter monitoring <br />system <br />29 <br />HSC 25298 (a) <br />Illegal abandonment of UST <br />system <br />30 <br />HSC 25298 (b) <br />Permit to temporarily close US - <br />system <br />31 <br />HSC 25298 (c) <br />Permit to close UST system <br />32 <br />HSC 25292.1 <br />UST system is operated to <br />prevent unauthorized release <br />33 <br />CCR 2650 <br />Recording/reporting <br />unauthorized release (M1) <br />34 <br />HSC 25291 (e) <br />Water in 20 cont analyzed and <br />properly disposed of <br />35 <br />CCR 2640 (e) <br />Single wall component within <br />1000' of Public Well, no ELD <br />36 <br />CCR 2635(a)(2)(A) Cathodic protection testing & <br />60 day inspection log (M2) <br />37 <br />H&SC 25299(a)(9) Disabling leak detect. Devices <br />38 <br />CCR 2715(a) <br />Statement from UST owner <br />39 <br />CCR 2715(c) <br />Monthly inspection by D.O, <br />40 <br />CCR 2715 (f) <br />D.O. trained employees <br />41 <br />Violation(s) not listed above <br />EHD INSPECTOR: PHONE:(;&V -n> <br />RECEIVED BY: TITLE: <br />Septic System: V ❑ Serves 2 20 persons/day ❑ Receives other than sanitary waste <br />Other Disposal Units Identi ❑ Dry wells/French Drains <br />I:%Units1Unit-1111UST1UST inspecbon8.19.04.DOC <br />