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SAN JOAQUIN COUNTY if <br /> *NVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,California 95202-3029 <br /> Telephone:(209)468-3420 Fax.(209)468-3433 Web:www.sgov_orw <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> te"�- <br /> Facility address: UST# , <br /> 'Product S <br /> F 'ity Contact: Title: Phone: <br /> ^ <br /> P'4 V. (oZ 423-7(0!0 - <br /> nit ing)Pa el: Piping system: Overfill prevention: <br /> IlG <br /> 11 Pressurized uction ❑Gravity echanical ❑Audible/visual <br /> Inspection type: Violations: <br /> outine konitoring Certification [I Installation El Other: ❑M1-RDetect ❑M2-RPrev ❑M-3 Both <br /> VIOLATION(S) HSC=California Health&Safety Code;CCR=Califomia Code of Regulations V R <br /> # Code Section V <br /> V=Violation;RV=Repeat Violation <br /> 1 HSC 25284 Permit tooperate _ <br /> 2 CCR 2637 Secondary containment test performed <br /> 3 CCR 2711 b & c) Current Unified Program Consolidated Forms on file with EHD(Facility and tank form) <br /> 4 HSC 25292.2 Certification of financial responsibility and CFO letter <br /> 5 CCR 2632(b) Monitoring Program(Monitoring&Response Plan is current and approved b the local agency. <br /> 6 CCR 2712(i) Monitoring plan is onsite. <br /> 7 CCR 2712 b) Maintenance&monitoring records Ml <br /> 8 CCR 2643(d) Daily monitoring of suction piping(pre-January, 1, 1984) <br /> 9 HSC 25292.1 UST system isoperated to prevent unauthorized release <br /> 10 CCR 2632(c)(2) UST monitoring system is present (MI) <br /> 11 CCR 2630 d) UST system monitoring equipment is properly located to detect a leak M1 <br /> 12 HSC 25291 ) UST system monitoring equipment isoperational (M2) <br /> 13 CCR 2636 1) Continuous monitoring system for underground piping&UDC is present (Mi) <br /> 14 CCR 2631 (a) Primary containment is product tight <br /> 15 HSC 25291 (a)(2) Secondary containment for UST is tight <br /> 16 CCR 2636 c)(1) All releases in secondary piping flow to a collection sum <br /> 17 HSC 25291 (f) Line leak detector(s)are installed (Ml) <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 Recording/reporting of unauthorized releases (Mi) <br /> 23 CCR 2715 Designated Operator:(a)Statement from UST owner; (c-e)Monthly inspection;(f)Employee training <br /> 24 CCR 2638 a Annual monitoring certification <br /> 25 CCR 2638(a) Annual line leak detector test (M1) <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> 27 1 CCR 2636(f)(4) Annual line tightness test (Mi) <br /> 28 CCR 2661 (f) Repair for tank/piping has had tightness test (M2) <br /> 29 1 CCR 2643 e) Biennial tightness test of gravity piping(pre-January 1, 1984) <br /> 30 CCR 2643(d) Triennial line test for conventional suction piping(pre-January 1, 1984) (M1) <br /> 31 HSC 25292.5 Double walls stem located within 1000'of public well-ELD <br /> 32 CCR 2661 Permit to repair UST system <br /> 33 HSC 25286 a) Permit to alter monitoring system <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) Disabling leak detection devices <br /> 37 HSC 25298 a) Ille al abandonment of UST system <br /> 3 Other: <br /> E D IN am�m <br /> E R: ONE: UIC <br /> -7 401 Septic system: <br /> 7 Serves>_20 people/day <br /> CEIVED BY: TITLE: 7 Receives other than sanitary waste <br /> ZLAL - Other disposal methods: <br /> F Dry wells/French Drains <br /> L vk4' -of <br /> EHD 23-02-002 REV 05/07 <br />