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6 SAN JOAQUIN COUNTY to <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, California 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd <br />UNDERGROUND STORAGE TANK JUST) PROGRAM INSPECTION REPORT <br />Facility name: Designated Operator: Inspection Date: <br />LJ A /06 <br />Facility address: <br />UST # <br />Product roduc t <br />Facility Contact: <br />ok+�- P-3,,,�rj,4 <br />Title: Phone: <br />/H4xqrt?-- <br />Monitoring Panel: <br />/piping system: <br />>-4-surized D Suction El Gravity <br />Overfill prevention: <br />11 Mechanical <br />ce . 20 -26 - <br />-_>dudible/visuale <br />Inspection type: Violations: <br />Zzoutine MI ct. <br />-aonitoring Certification 11 Installation 11 Other: El M I -RDetect El M2-RPrev El M-3 Both <br />VIOLATION(S) HSC=Califomia Health & Safety Code; CCR=Califomia Code of Regulations V R <br /># Code Section V=Violation; RV=R2eat Violation V <br />I <br />HSC 25284 <br />Permit too2erate <br />2 <br />CCR 2637 <br />Secondary containment test 2erfortned <br />3 <br />CCR 2711 (b) & (c) <br />Current Unified Pro ram Consolidated Forms on file with EHD Facility and tank formL__ <br />4 <br />HSC 25292.2 <br />Certification of financial res2onsibility and CFO letter 10 <br />5 <br />CCR 2632 (b) <br />Monitoring Proram Monitoring & Response Plan) is current and approved by the local aEenc y. <br />6 <br />CCR 2712 (i) <br />MonitorinE Elan is onsite. <br />7 <br />CCR 2712 (b) <br />Maintenance & monitorinE records i) <br />8 <br />CCR 2643 (d) <br />Daily monitoring of suction piping (pre-Jannaa, 1, 1984) <br />9 <br />HSC 25292.1 <br />UST system iso2erated to revent unauthorized release <br />10 <br />CCR 2632 (c)(2) <br />UST monitoring system is present (Mu <br />I I <br />CCR 2630 (d) <br />UST system monitoninE egaMMiEenntLlilErEo2p2EerEllyllo2c2a2tcMd to detect a leak M1) <br />12 <br />HSC 25291 (b) <br />UST system monitoring egui2ment iso2erational (M2) <br />13 <br />CCR 2636 (D(I) <br />Continuous monitorinE system for under round 2ieinE & UDC is 12resent (Ml) <br />14 <br />CCR 2631 a) <br />Primary containment is 2roduct ti ht <br />15 <br />HSC 25291 (a)(2) <br />Secondary containment for UST is tight <br />16 <br />CCR 2636 c)I) <br />All releases in secondary 2i2inE flow to a collection sum2 <br />17 <br />HSC 25291 (D <br />Line leak detector(s) are installed (l) <br />18 <br />CCR 2635 (b)(1) <br />Spill container (M2) <br />19 <br />CCR 2635 (b)(2)_ <br />Overfill 2revention system (M2) <br />20 <br />CCR 2636 (a) <br />Conventional suction 2i2inE shall have continuous monitorin& 2' containment <br />21 <br />HSC 25291 (e) <br />Water in 2' containment analyzed & pro2erly dis2)sed of <br />22 <br />CCR 2650 <br />Recording/reporting of unauthorized releases (M 1) <br />23 <br />CCR 2715 <br />DesiEnated 02crator: (a) Statement from UST owner; (c -e) Monthly ins2ection; (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 (M1) <br />26 <br />HSC 25284.2 <br />Annual spill containment testing <br />27 <br />CCR 2636 4) <br />Annual line tightness test (M 1) <br />28 <br />CCR 2661 (D <br />Re air for tank/piping has had tightness test (M2) <br />29 <br />CCR 2643 (e) <br />Biennial tightness test of gravity piping (pre -January 1, 1984) <br />30 <br />CCR 2643 (d) <br />Triennial line test for conventional suction piping (pre -January 1, 1984) (M 1) <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 re air UST system <br />33 <br />HSC 25286 (a) <br />Permit to alter monitoring system <br />34 <br />HSC 25298 (b) <br />Permit to tem2orarily close UST system <br />35 <br />HSC 25298 (c) <br />Pen -nit to close UST system <br />36 <br />HSC 25299 (a)(9) <br />Disabling leak detection devices <br />37 <br />HSC 25298 a)abandonment <br />of UST system <br />I <br />38 Other: <br />EHD INSPECTOR- PHONE: <br />14% &.- 1 -6Ea <br />RECEIVED BY':--/' TITLE: <br />tz <br />Septic system: UIC <br />-Serves 2!20 people/day <br />— Receives other than sanitary waste <br />Other disposal inethods. <br />Dry wells/French Drains <br />EHD 23-02-002 REV 05/07 <br />