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SAN JOAQUIN COUNTY <br /> *�NVIITRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,California 95202-3029 <br /> Telephone: (209)468-3420 Fax:(209)468-3433 Web:www.sjgoy.org�eh <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: _Designated Operator: Inspection Date: <br /> A thij <br /> Facility address: UST#f T <br /> I I/ / <br /> ql wu� L-Product <br /> [Facility dontact: Title: Phone: ------T-71 <br /> q itoring'Panel: piping system: Overfill prevention: <br /> !6- <br /> x f 1];S—Pressurized Suction YSMechanical 11 Audible/visual <br /> Inspection type:pe: Violations: [XNV-RPrev [11 M-3 Both <br /> if Routine Monitoring Certification ❑L Installation El Other: ❑0 M I-RDetect <br /> VIOLATION(S) HSC=California Health&Safety Code;CCR=Califomia Code of Regulations V R <br /> # Code Section V=Vi V <br /> I HSC 25284 Permit to overate <br /> 3F2 CCR 2637 Secondary containment test performed <br /> CCR 2711 (b)&(c) Current Unified Program Consolidated Forms on file with EHD(Facili!y and tank form) <br /> 4 HSC 25292.2 __Certification of financial responsibility and CFO letter <br /> 5 CCR 2632(b) Monitori y the local Mency. <br /> 6 CCR 2712(i) Monitoring plan is onsite. <br /> 7 CCR 2712(b) Maintenance&monitorin <br /> 8 CCR 2643(d) Daily monitoring of suction <br /> 9 HSC 25292.1 UST system isoperated to prevent unauthorized release <br /> 10 CCR 2632(c)(2) UST monitorin s stem is present (Mi) <br /> 11 CCR 2630(d) UST system monitorin e ui ment is properly located to detect a leak (Mi) <br /> 12 HSC 25291 (b) UST s stem monitorin ui ment isoperational (M2) <br /> 13 CCR 2636(f)(1) Continuous�monitcrisystem for undeFIround piping&UDC is present (Mi) <br /> -_FCCR 2631(a) Primary <br /> 14containment is roduct ti ht <br /> 15 HSC 25291 (a)(2) Seconda containment for UST is ti ht <br /> 16 CCR 2636(c)(I) _. All releases in seconda i in floe to a collection sum <br /> 17 HSC 25291 (f) Line leak detector(s)are installed (Mi) <br /> 18 CCR 2635(b)(1) Spill container (M2) <br /> 19 CCR 2635(b)(2) Overfill prevention system (M2) <br /> 20 CCR 2636(a) Conventional suction piping shall have continuous monitoring&2'containment <br /> 21 HSC 25291 (e) Water in 2'containment analyzed&properly disposed of <br /> 22 CCR 2650 Recordin /reporting of unauthorized releases (MI) <br /> 23 CCR 2715 Designated 02erator:(a)Statement from UST owner; (c-e)Monthly ins pecti n;(f)Ernpl2yee training <br /> 24 CCR 2638(a) L,Annual monitoring certification <br /> 25 CCR 2638(a) Annual line leak detector test (MI) <br /> 26 HSC 25284.2 Annual spill containment testing <br /> 27 CCR 2636(f)(4) Annual line tightness test (MI) <br /> 28 CCR 2661 (f) (M2) <br /> 29 CCR 2643(e) Biennial tightness test of avitv i in re-Janua. 1, 1984) <br /> 30 CCR 2643(d) Triennial line test for conventional suction pi2in (pre-January 1, 1984) (Mi) <br /> 31 HSC 25292.5 Double walls stem located within 1000'of ublic well-ELD <br /> 32 CCR 2661 Permit to re air UST system <br /> 33 HSC 25286 a)._ Pen-nit to alter monitorin s stem <br /> 34 HSC 25298(b) Permit to temporarily close UST system <br /> 35 HSC 25298(c) --Permit to close,UST system <br /> 36 HSC 25299(a)(9) jDisablin ji�bh leak detection devices <br /> 37 HSC 25298(a) ills al abandonment of UST s stem <br /> 38 Other: <br /> Ell INSP CTOR: PHONE- Septic system: UIC <br /> mot 7.Serves>_20 people/day <br /> R CEIVE BBy.Y: THE- Receives other than sanitary waste <br /> Other disposal methods: <br /> A V'Ir <br /> Pr'Sopor Dry wells/French Drains <br /> EHD 23-02-002 REV 05/07 <br />