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.t� AN JOAQUIN COUNTY <br />R'r MENTAL HEALTH DEPARTMENTV <br />304 ); st eber Avenue, -P Floor, Stockton, CA 9520 -27 <br />V Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.si og v.org <br />UNDERGROUND STORAGE TANK ST PROGRAM INSPECTION REPORT <br />"I <br />Secon containment for UST is ti ht <br />Facility name: <br />Designated Operator: - <br />Inspection Date: <br />n a CCk1�C ion sum <br />� * <br />Facility address:UN <br />QA�11 <br />US l' l <br />. 1, A"" H- <br />T <br />A T <br />l <br />CCI 265 1: <br />'111 container <br />Facility Contact: Titled Phone: <br />HKE <br />/ <br />O� <br />verfill revention s -tem <br />MZ <br />Cwt 2636 ) <br />Mo storing Panels <br />� lri <br />Piping system: // �/ <br />❑ Pressurized Wsuction LrlGravi <br />rfill prevention: <br />L mechanical ❑ Audible/visual <br />HSC 25291 (e) <br />Water in 2° containment anal ed & EL2eerly disposed of <br />In,i pection type: <br />L7 Routine 0 Monitoring Certification ❑ Installation ❑ Other: <br />Violations: <br />0 Ml-RDetect dM2-RPrev <br />❑ M-3 Both <br />23 <br /># Code Section <br />VIOLATIONS) HSC=Califomia Health & Safety Code; CCR=California Code of Regulations <br />V=Violation; RV=Re eat Violation <br />V R <br />V <br />.tCR 2638 a) <br />Arirual monitorin "certification <br />1 HSC 25284 <br />Permit tooperate <br />CCR 2638 (a) <br />Annual line leak detector test <br />I <br />2 CCR 2637 <br />Secondary containment test perfomecl <br />Annual spill containment tc tin <br />S <br />3 CCR 2711 & c <br />Current Unified Program Consolidated Forms on file with EHD(Facility and tank form) <br />I <br />aii `for tank/piping has'tad ti tress tit' <br />HSC 25292.2 <br />Certification of financial r*onsqft and CFD letter <br />CCR 2643 a <br />Biennial tightness test of gravity piping(pr -Januaiy 1, 1984 <br />5 CCR 2632 c 2 D <br />Monitoring& response plan is current and filed with the local agency <br />line test for conve` Wsuction piping: u ':1 l <br />1 <br />31 <br />`6 CCR 2712 .i <br />Monitorin" & response plan is onsite <br />2 <br />CCR 2661 <br />` 7 CCR 2712 <br />Maintenance &monitorin records <br />Ml <br />HSC 25286 a <br />Permit to alter monitorings stem <br />8 CCR 2643 (d <br />Daily moni toring of suction i in (re -Jana 1, 1';9$4) „ <br />SC 25298 (b ,. <br />. <br />„'` t #,'; 1UST <br />9 HSC 25292.1 <br />UST system isoperated to prevent unauthorized release <br />Permit to close UST s stem <br />17 CCR 2632 (p)(2) <br />ST . " is"resent <br />M1 <br />37 <br />HSC 25298 (a) <br />1 I CCR 2630 d <br />UST s m monitorin equipment is properly located to detect a leak <br />Ml <br />12 'H 25291, ... ' <br />iJST system mot't€t' isoperational <br />13 CCR 2636 1 <br />Continuous monitoring system for underground piping & UDC is present <br />Ml <br />, :wia s%arrtif'.� ii.'tx nli <br />;, ,- <br />15 <br />HSC 2529.1 (a)(2) <br />Secon containment for UST is ti ht <br />fi _ <br />L f <br />n a CCk1�C ion sum <br />� * <br />'17 <br />HSC 25291 <br />Line leak detectodq are installed1 <br />l <br />CCI 265 1: <br />'111 container <br />- . �. <br />' 19 <br />CCR 2635 2 <br />O� <br />verfill revention s -tem <br />MZ <br />Cwt 2636 ) <br />Conventional iti6 # " " " »shai€E- ' ue.cot tt ous n nitorin' & 2° contatnrtt ,nt <br />21 <br />HSC 25291 (e) <br />Water in 2° containment anal ed & EL2eerly disposed of <br />23 <br />CCR 2715 <br />DesignatedOperator: (a Statement from UST owner; (c -e) Monthly inspection; n; <br />E to ee training <br />.tCR 2638 a) <br />Arirual monitorin "certification <br />25 <br />CCR 2638 (a) <br />Annual line leak detector test <br />I <br />a <br />HSC 2524. <br />Annual spill containment tc tin <br />S <br />CCR 2636 4 <br />Annual line tightness test <br />I <br />aii `for tank/piping has'tad ti tress tit' <br />29 <br />CCR 2643 a <br />Biennial tightness test of gravity piping(pr -Januaiy 1, 1984 <br />line test for conve` Wsuction piping: u ':1 l <br />1 <br />31 <br />HSC 25292.5 <br />Double wall s stem located within 1000' of public well-ELD <br />2 <br />CCR 2661 <br />USTs stem <br />33 <br />HSC 25286 a <br />Permit to alter monitorings stem <br />SC 25298 (b ,. <br />. <br />„'` t #,'; 1UST <br />35 <br />HSC 25298 (c) <br />Permit to close UST s stem <br />2529 (a)(9 <br />66 A*HC <br />Dtsablinkddeaq s <br />37 <br />HSC 25298 (a) <br />I Illeeal abandonment of UST system <br />SP PHONE: UIC <br />Septic system: <br />❑ Serves >_20 people/day <br />E TITLE: Receives other than sanitary waste <br />t ' Other disposal methods: <br />ftlUt.� &C k Y+l► w t t ✓ Dry wells/French Drains <br />D <br />EHD 23-02-002 <br />1 <br />