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a <br /> AN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton,California 95202-3029 <br /> Telephone:(209)468-3420 Fax. (209)468-3433 eb®www s' gehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT - --------- <br /> Facility name: Designated Operator: Inspection Date: <br /> Facility a ress: UST# q , <br /> Product <br /> FWitycontact. 'Title: Phone: <br /> c i i <br /> 1011101 <br /> toring Pan Piping system. Overfill prevention: <br /> i Pressurised Suction ❑Gravi Mechanical udible/vimal <br /> rRotutine <br /> ection type: Violations: <br /> Monitoring Certification ❑Installation ❑Other: ❑M1-RDetect ❑M2-RPrev ❑ -3 Both <br /> HSC=California Health&Safety Code;CCR=California Code of Regulations V R <br /> Code Sectio V <br /> V=Violation;RV=R eat Violation <br /> 25284 Permit too erste <br /> 2 CCR 2637 Seconds containment test erfo ed <br /> 3 CCR 2711 b)&c c) Current Unified Pro am Consolidated Fo son fide with EHI3 Facili and tank form <br /> 4 HSC 25292.2 Certification of financial res onsibilit d CFO letter <br /> 5 CCR 2632(b) Mal 311 Pro am Monitorin &Res once Plan)is current and proved b the local a enc . <br /> 6 CCR 2712(i) Monitorin lin is onsitea <br /> 7 CCR 2712 b) Maintenance&monitorin records l <br /> 8 CCR 2643 d) Dail monitorin of suctiore®Janus , 1, 1984) <br /> 9 HSC 25292.1 UST s stem iso erated to revent unauthorized release <br /> 10 CCR 2632 c)(2) UST monitorin s stem is resent (Mi) <br /> 11 1 CCR 2630 d) UST s stem monitorin a ui mentis ro erl located to detect a leak M1 <br /> 12 HSC 25291 b) UST s stem monitorin e ui ment iso erational (M2) <br /> 13 CCR 2636 1 Continuous monitorin s stem for under ound i in c4c UDC is resent ( 1) <br /> 14 CCR 263 fl a) Prima containment is roduct ti ht <br /> 15 FISC 25291 a) 2 --S—econdary containment for UST is ti ht <br /> 16 CCR 2636(c)(1) All releases in seconds i in flow to a collection sum <br /> 17 HSC 25291 (f) Line leak detector s)are installed (Mi) <br /> 18 CCR 2635(b)(1) Sill container (M2) <br /> 19 CCR 2635 b) 2) Overfill revention system (M2) <br /> 20 CCR 2636(a) Conventional suction i in shall have continuous monitorin 2°containment <br /> 21 HSC 25291 (e) Water in 2°containment analyzed properly disposed of <br /> 22 CCR 2650 Recordin /re ortin of unauthorized releases (Ml) <br /> 23 CCR 2715 Desi nated Operator:(a)Statement from UST owner; (c-e)Monthly inspection;(f)Employee training <br /> 24 CCR 2638 aAnnual monitorin certification <br /> 25 CCR 2638(a) Annual line leak detector test (Ml) <br /> 26 HSC 25284.2 Annuals ill containment testin <br /> 27 CCR 2636 f)4) Annusl lined fitness test Ml) <br /> 28 CCR 2661 (f) R air for tank/ i in has had ti htness test (M2) <br /> 29 CCR 2643(e) Biennial tightness test of ravit i in re-Janua 1, 1984 <br /> 30 CCR 2643(d) Triennial line test for conventional suction i in re-Jana 1, 1984) (M1) <br /> 31 HSC 25292.5 Double wall s stem located within 1000'of ublic well-ELD <br /> 32 CCR 2661 Permit to r air UST s stem <br /> 33 HSC 25286 a) Permit to alter monitorin s stem <br /> 34 HSC 25298(b) Permit to t oraril close UST s stem <br /> -3 5 HSC 2529$ c Permit to close UST s stem <br /> 36 HSC 25299(a)9) Disablin leak detection devices <br /> 37 HSC 25298 a) [lie sl abandonment of UST s stern <br /> 8 Other: <br /> IN PE 1f' <br /> t ONE: U[C <br /> 0*1-� - SWtic system: <br /> RS " <br /> Serves>_20 people/day <br /> IVE Y: TIT1,E: F Receives other than sanitary waste <br /> Other disposal methods: <br /> wells/French Drains <br /> EHD 23-02-002 REV 05/07 <br />