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SAN JOAQUIN COUNTY <br />*NVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, California 95202-3029 <br />Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: ehd <br />UNDERGROUND STORAGE TUST) PROGRAM INSPECTION REPORT <br />Facility name: Designated Operator: Inspection Date: <br />A I (AL4 PAV WISIA <br />Facility labdr ss: UST # <br />MR41V I Y1 - 'Product <br />Facility Contact: <br />V&mt <br />Title: Phone: <br />V 1 1 Uf 00 40 <br />it0r,ing Pane : <br />I Piping system: <br />Pressurized ESuction 1Gravi <br />Overfill prevention: <br />EMechanical Audible/visual <br />Inspectiontype: <br />it Routine TAMonitoring <br />Certification El Installation El other: <br />Violations: <br />El M I -RDetect [j' M2-RPrev [I M-3 Both <br /># <br />Code Section <br />VIOLATION(S) HSC=Califomia Health & Safety Code; CCR=Califomia Code of Regulations V R <br />V=Violation; RV=Repeat Violation V <br />HSC 25284 <br />Permit tooperate <br />2 <br />CCR 2637 <br />Second 2a containment test performed <br />3 <br />c <br />Unified Program Consolidated Forms on file with EHD (Facility and tank form) <br />4 <br />HSC 25292.2 <br />-Current <br />Certification of 1 [ responsibility and CFO letter <br />5 <br />CCR 2632 (b) <br />Monitoring Program (Monitorin& Response Plan) is current and approved by the local Mency. <br />6 <br />C <br />Monitoring plan is onsite. <br />7 <br />CCR 2712 (b) <br />Maintenance & monitoring records (Mi) <br />8 <br />CCR 2643 (d) <br />Daily monitoring of suction piping (pre -January, 1, 1984) <br />9 <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 (Mi) <br />11 <br />CCR 2630 (d) <br />UST system monitorinuiRment is properly located to detect a leak (Mi) <br />12 <br />HSC 25291 (b) <br />UST system monitorina2qHui�ment iso erational (M2) <br />13 <br />CCR 2636 (0(1) <br />Continuous monitoring system for underground 2i2ing & UDC is present (Mi) <br />14 <br />CCR 2631 (a) <br />Primary containment is product tight <br />- <br />-THSC 25291 (a)( <br />Secondary containment for UST is tight <br />16 <br />CCR 26326 c)(1) <br />All releases in seconda iping flow to a collection sump <br />17 <br />HSC 25291 (f) <br />Line leak detector(s) are installed (Mi) <br />-T8 <br />CCR 2635 (b) 1) <br />Spill container (M2) <br />14 <br />CCR 2635 (b)(2) <br />Overfill prevention system (M2) <br />20 <br />CCR 2636 (a) <br />Conventional suction 2i2ing 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 />Recordi2EVr22orqtiLn�ofunauthorized releases ON (MI) <br />23 <br />CCR 2715 <br />Designated 2perator: (a) Statement from UST own ispection; (f) Employee training <br />ri <br />24 <br />CCR 2638 (a) <br />Annual monitoring certification <br />25 <br />CCR 2638 (a) <br />Annual line leak detector test (Mi) <br />26 <br />HSC 25284.2 <br />Annual spill containment testing <br />27 <br />CCR 2636 (f)(4) <br />Annual line tightness test (Mi) <br />28 <br />CCR 2661 (f) <br />E_Tair for tank/ i in has had tightness test (M2) <br />29 <br />CCR 2643 (e) <br />Biennial tightness test of Eavity piping (pre -January 1, 1984) <br />30 <br />CCR 2643 (d) <br />Triennial line test for conventional suction 12ij!ing (re -Jams 2g 1, 1984) (Mi) <br />31 <br />HSC 25292.5 <br />Double wall system located within 1000' of public well-ELD <br />32 <br />CCR 2661 <br />Permit to E�air UST �syst <br />33 <br />HSC 25286 (a) <br />Permit to alter monitorin system <br />34 <br />HSC 25298 (b) <br />Permit to_tem porarily close UST system <br />35 <br />1 HSC 25298 (c) <br />Permit to close UST system <br />36 <br />HSC 25299 (a)(9) <br />leak detection devices <br />37 <br />HSC 25298 (a) <br />_2j!!Lblan <br />I Illegal abandonment of UST system <br />38 <br />Other: <br />I <br />INSPECTOR: <br />LfA 411tAffC <br />CEIVh1rWr-4 <br />C ol <br />PHONE: <br />10, If TITLE:� <br />LI/ U <br />UIC <br />Sematic system: <br />Serves �!20 people/day <br />11 Receives other than sanitary waste <br />Other disposal methods: <br />71 Dry wells/French Drains <br />EHD 23-02-002 REV 05/07 <br />