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P WIC HEALTH SERVICES SAN JOAQ COUNTY DATE ASA <br />V_ <br />ENVIRONMENTAL HEALTH DTVI N PAGE \ 0''F <br />304 E. Weber Ave., Third Floor, Stockton, CA 95202 <br />(209) 468-3420 <br />UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br />Facility Named°F '%\W60 -f- Facility Address <br />HSC 25291 (e) <br />8 <br />Facilty Contactt'� TitleCA\'F <br />*\\i? <br />Phone <br />UST#'.\ - Products UST#_Product <br />UST#_Product UST# <br />Pfduct�_ <br />Overfill Prevention: AudibleNisual cchaRZ y <br />HSC 25291(a)(2) <br />Monitoring Panel: ' <br />= <br />Piping System: ravityqr6-:,ssTL--­- <br />GSuction <br />Automatic Pump Shut Down SatQB2636.(g): �?��): <br />rYes <br />Violations: inor <br />Dispenser Pan: Yes <br />Major <br />No. <br />INSPECTION TYPE: 'outin 1,�6nitoring Cgadication mom aint Install Removal Repair/Upgrade <br />COMPANY NAME: ; TECHNICIAN NAME: PN4xZi PHONE: <br />Src�V\C�. <br />`SSP\ -\\iv, <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 2630 (d) <br />6 CCR 2636 (c)(1) <br />7 <br />HSC 25291 (e) <br />8 <br />HSC 25291 (f) <br />9 <br />CCR 2636 (f)(1) <br />10 J <br />CCR 2632 (c)(2) <br />11 <br />HSC 25291(a)(2) <br />12 <br />CCR 2636 (f)(1) <br />13 <br />CCR 2635 (b)(1) <br />14 <br />CCR 2635 (b)(2) <br />15 <br />CCR 2631 (a) <br />16 <br />HSC 25292.1 <br />17 <br />CCR 2650 <br />18 <br />CCR 2632 (d) <br />Permit to operate <br />19 <br />CCR 2712 (i) <br />Monitoring & response plan <br />Secondary cont testing (6 <br />is on site <br />month/36 month) <br />20 <br />CCR 2712 (b) <br />Maintenance & monitoring <br />Current State Forms A & B <br />records <br />Certification of financial <br />21 <br />CCR 2636 (f)(4) <br />Annual line tightness test <br />responsibility and letter from <br />22 <br />CCR 2630 (d) <br />Annual line leak detector test <br />chief financial officer <br />23 <br />CCR 2630 (d) <br />Annual monitoring <br />Continuous monitoring <br />certification <br />system for UST system <br />24 <br />CCR 2643 (d) <br />Daily monitoring of suction <br />All releases in secondary <br />piping that is not <br />piping flow to a collection <br />continuously monitored <br />sump <br />25 <br />CCR 2643 (d) <br />Triennial tightness test of <br />Water in secondary (20) cont <br />suction piping that is not <br />Automatic line leak <br />continuously monitored <br />detector(s) <br />26 <br />CCR 2643 (e) <br />Biennial tightness test of <br />Continuous monitoring <br />gravity piping that is not <br />system for underground <br />continuously monitored <br />piping <br />27 <br />CCR 2662 <br />Upgrade requirements for <br />Continuous monitoring <br />UST system <br />system for UST <br />28 <br />CCR 2661 <br />Permit to repair UST system <br />Secondary containment for <br />29 <br />HSC 25286 (a) <br />Permit to alter monitoring <br />UST is tight <br />system <br />Continuous monitoring <br />30 <br />HSC 25298 (a) <br />Illegal abandonment of UST <br />system for dispenser system <br />system <br />Spill container <br />31 <br />HSC 25298 (b) <br />Permit to temporarily close <br />Overfill prevention system <br />UST system <br />Primary containment is <br />32 <br />HSC 25298 (c) <br />Permit to close UST system <br />product -tight <br />33 <br />HSC 25291 (e) <br />Water in 20 cont analyzed <br />UST system is operated to <br />and properly disposed of <br />prevent unauthorized release <br />34 <br />CCR 2640 (e) <br />Single wall component within <br />Recording/reporting <br />1000' of Public Well, no ELD <br />unauthorized release <br />36 <br />CCR 2635(a)(2)(A) Cathodic protection testing <br />Monitoring & response plan <br />35 <br />Violation(s) not listed above <br />EHD INSPECTO PHONE: n�DN 101 <br />RECEIVED B : -- TITLE: (\j,}, ._ PHONE: ZLI Ci tM5 l Z� <br />UNITIII/UST/INSP (rev 12/19/01) <br />