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*SAN JOAQUIN COUNTY <br />ONMENTAL HEALTH DEPARTMENT <br />304 East Weber Avenue, 3d Floor, Stockton, CA 95202-2746 <br />Telephone. (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.or�d <br />UNDERGROUND STORAGE TANK (UST I PROGRAM <br />INSPECTION REPORT <br />Facility name: <br />V R <br />V <br />Designated Operator: Inspection Date: <br />vweie- HMR(r)7rt- <br />Permit to operate <br />ZTPO-A&S ftkZ6 <br />Facility address: <br />CCR 2637 <br />UST # 7' <br />W - %lo-cwtTr Av"ut-F <br />CCR 2711 (b) & (c) <br />Product <br />Facility Contact: Title: <br />Phone: <br />Certification of financial responsibility and CFO letter <br />IftW11515 <br />CCR 2632 (c)(2)(D) <br />MonitorinS & response plan is current and filed with the local agency <br />Monitoring Panel: <br />Piping system- <br />Monitoring & response plan is onsite <br />Overfill prevention: <br />0 wgws Co(U11 WC, <br />Oressurized 0 Suction <br />El Gravity <br />[mechanical El Audible/visual <br />Ins ectioln type: <br />CCR 2643 (d) <br />Violations: <br />outine 1P4onitoring Certification 11 Installation <br />0 Other: <br />El M I -RDetect El M2-RPrev El M-3 Both <br /># <br />Cod I e Section <br />VIOLATION(S) HSC=Califomia Health & Safety Code; CCR=Califomia Code of Regulations <br />V=Violation; RV=Re2eat Violation <br />V R <br />V <br />I <br />HSC 25284 <br />Permit to operate <br />2 <br />CCR 2637 <br />Secondary containment test;j2erfonned <br />3 <br />CCR 2711 (b) & (c) <br />Current Unified Program Consolidated Forms on file 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 (c)(2)(D) <br />MonitorinS & response plan is current and filed with the local agency <br />6 <br />CCR 2712 (i) <br />Monitoring & response plan is onsite <br />7 <br />CCR 2712 (b) <br />Maintenance & monitorinE records <br />(Mi) <br />8 <br />CCR 2643 (d) <br />Daily monitoring of suction piRLn2 (gre-January, 1, 1984) <br />9 <br />HSC 25292.1 <br />UST system isoperated to revent unauthorized release <br />10 <br />CCR 2632 (c)(2) <br />UST monitoring gstem is present <br />M <br />11 <br />CCR 2630 d) <br />UST system monitoring equipment is properly located to detect a leak <br />(Mi) <br />12 <br />HSC 25291 L <br />UST system monitoring equiLxnent is 2perational <br />(N12) <br />13 <br />CCR 2636 (f)(1) <br />Continuous monitoring system for underground piping & UDC is present <br />(Mi) <br />44 <br />CCR 2631 (a) <br />Primary containment is roduct tight <br />15 <br />HSC 25291 a)(2) <br />containment for UST is tight <br />16 <br />17 <br />CCR 2636 (c)(1) <br />HSC 25291 (f) <br />_§SS2ndaa <br />All releases in second 2a pipm flow to a collection suEM <br />Line leak detector(s) are installed <br />(Mi) <br />18 <br />CCR 2635 (b)(1) <br />§1ill 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 & 20 containment <br />21 <br />HSC 25291 (e) <br />Water in 2' containment analyzed & Rroperly disposed of <br />22 <br />CCR 2650 <br />Recording/reporting of unauthorized releases <br />(Mij <br />23 <br />CCR 2715 <br />Designated 22erator: (a) Statement from UST owner; (c-eMonthly ins2ection; (f) Employee training <br />4— <br />CCR 2638 (a) <br />Annual monitoring certification <br />25 <br />CCR 2638 (a) <br />Annual line leak detector test <br />(Mi) <br />26 <br />27 <br />HSC 25284.2 <br />CCR 2636 (f)(4) <br />Annual Rill containment testing <br />Annual line tightness test <br />(Mi) <br />28 <br />CCR 2661 (f) <br />Repair for tank/piping has had tightness test <br />(M2) <br />29 <br />CCR 2643 <br />(e) <br />Biennial tightness test of gravity pipinE (gre-Janus 1, 1984) <br />30 <br />CCR 2643 <br />(d) <br />Triennial line test for conventional suction 'i in (pre -January 1, 1984) <br />(Mi) <br />31 <br />HSC 25292.5 <br />Double wall system located within 1000' of 2ublic 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 <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)(91 <br />Disabling leak detection devices <br />37 <br />HSC 25298 (a) <br />llleEal abandonment of UST system <br />38 <br />n+u- <br />r: I <br />EHD INSPECTOR: PHONE: UIC <br />IV\ T>4^ 'Pt Septic system: <br />Serves �!20 people/day <br />RECEIVED BY: TITLE: L—j Receives other than sanitary waste <br />Other disposal methods: <br />ACWTALM 0416r Ll wells/French Drains <br />--17T <br />FHT) 23-02-002 <br />