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• SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, California 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.org/ehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br />Facility name: I / <br />Designated Operator: <br />Inspection Date: <br />� <br />Facility address: <br />UST # <br />Product <br />t1V�/iL <br />I , <br />F ty71 <br />t'r Title: Phone: <br />VIII��- <br />/ <br />//Monitoring Panel <br />e!I I >E-Niressurized <br />Piping system: <br />XSuction ❑ Gravity <br />Overfill prevention: <br />anical Audible/visual <br />Inspection type <br />Routine onitorin <br />Certification ❑ Installation ❑ Other: <br />tViolations: <br />RDetect ❑ M2-RPrev <br />-3 Both <br /># <br />Code Section <br />VIOLATION(S) HSC=California Health & Safety Code; CCR=California Code of Regulations <br />V=Violation; RV=Re eat Violation <br />V R <br />V <br />1 <br />HSC 25284 <br />Permit tooperate <br />2 <br />CCR 2637 <br />Secondary containment test erformed <br />3 <br />CCR 2711 b) & c <br />Current Unified Program Consolidated Forms on the with EHD(Facility and tank form) <br />4 <br />HSC 25292.2 <br />Certification of financial responsibility and CFO letter <br />5 <br />CCR 2632 b <br />Monitoring Program(Monitoring & Response Plan) is current and approved by the local agency. <br />6 <br />CCR 2712 i) <br />Monitoring Ian is onsite. <br />7 <br />CCR 2712 b <br />Maintenance & monitoring records <br />M 1 <br />8 <br />CCR 2643 d) <br />Daily monitoring of suction piping (pre -January, 1, 1984) <br />9 1 <br />HSC 25292.1 <br />UST system isoperated to prevent unauthorized release <br />10 <br />CCR 2632 c)(2) <br />UST monitoring system is present <br />(M 1) <br />1 1 <br />CCR 2630 d <br />UST system monitoring equipment is properly located to detect a leak <br />M 1) <br />12 <br />HSC 25291 b) <br />UST system monitoring equipment isoperational <br />(M2) <br />13 <br />CCR 2636 1 <br />Continuous monitoring system for underground piping & UDC is present <br />M1 <br />14 <br />CCR 2631 a) <br />Primary containment is product tight <br />15 1 <br />HSC 25291 (a)(2) <br />Secondary containment for UST is tight <br />16 <br />CCR 2636 (c)(1) <br />All releases in secondary pipingflow to a collection sum <br />17 <br />HSC 25291 <br />Line leak detectors are installed <br />M1) <br />18 <br />CCR 2635 (b)(1) <br />Spill container <br />(M2) <br />19 <br />CCR 2635 (b)(2) <br />Overfill prevention system <br />(M2) <br />20 <br />CCR 2636 (a) <br />Conventional suction piping shall have continuous monitoring & 2° containment <br />21 <br />HSC 25291 (e) <br />Water in 2° containment analyzed & properly disposed of <br />22 <br />CCR 2650 <br />Recording/reporting of unauthorized releases <br />(M1) <br />23 <br />CCR 2715 <br />Designated Operator: (a) Statement from UST owner; (c -e) Monthly inspection; (t) Employee training <br />24 <br />CCR 2638 a <br />Annual monitoring certification <br />25 <br />CCR 2638 a) <br />Annual line leak detector test <br />(M1) <br />26 <br />HSC 25284.2 <br />Annuals ill containment testing <br />27 <br />CCR 2636 (f)(4) <br />Annual line tightness test <br />M1) <br />28 1 <br />CCR 2661 f) <br />Repair for tank/piping has had tightness test <br />(M2) <br />29 <br />CCR 2643 e <br />Biennial tightness test of gravity pipingre-Janus 1, 1984 <br />30 <br />CCR 2643 d) <br />Triennial line test for conventional suction piping (re -Janus 1, 1984) <br />(M1) <br />31 <br />HSC 25292.5 <br />Double walls stem located within 1000' of public well-ELD <br />32 <br />CCR 2661 <br />Permit to repair UST system <br />33 <br />HSC 25286 a) <br />Permit to alter monitoring system <br />34 1 <br />HSC 25298 b) <br />Permit to temporarily close UST system <br />35 <br />HSC 25298 c) <br />Permit to close UST system <br />36 <br />HSC 25299 (a)(9) <br />Disabling leak detection devices <br />37 <br />HSC 25298 a) <br />I Illegal abandonment of UST system <br />38 <br />Other: <br />D INSPECT <br />PHONE: U[C <br />3� Septic system: <br />Serves >:20 people/day <br />1 - Receives other than sanitary waste <br />.S t 3 ao rT�vl 1 T� c p Other disposal methods: <br />`�— -Dry wells/French r7rains <br />R CEI D BY: <br />v <br />EHD 23-02-002 REV 05/07 <br />