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0 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.sjgoy.orgIehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> P , I y <br /> -5111'6 -1 L Aie-�t- —J5 b&-1 <br /> Facility address: UST# <br /> 2— <br /> Product <br /> Facility Contact. Title: Phone: 71 <br /> Monitoring hinel: Piping stem: Overfill prevention: <br /> )6ressurized El Suction D Gravity %64echanical El Audible/visual <br /> Inspection type: r 11 i Violations: <br /> ,11404- or <br /> LP':'F 1, <br /> -1 <br /> 0 Routine 2!Lmonitoring Certification El Installation El Other: El M I-RDetect &M-2-RPrev 0 M-3 Both <br /> # Code Section VIOLATION(S) HSC=California Health&Safety Code;CCR=California Code of Regulations 17 R <br /> V=Violation;RV=Repeat Violation V <br /> I HSC 25284 Permit to operate <br /> 2 CCR 2637 Second M containment test performed <br /> 3 CCR 2711 b)&(c) Current Unified Program Consolidated Forms on file with EHD_LFacility and tank form) <br /> 4 HSC 25292.2 Certification of financial responsibility and CFO letter <br /> 5 CCR 2632(b) Monitorin Program Monitoring&Res2onse Plan)is current and approved by the local agency <br /> 6 1 CCR 2712 i) Monitoring 21an is onsite. <br /> -7 CCR 2712(b) Maintenance&monitoring records (M!L-- <br /> 8 CCR 2643 d) Dail X monitoring of suction 2i2inre-Januaa, 1, 1984) <br /> 9 HSC 25292.1 UST system isoperated to prevent unauthorized release <br /> 10 CCR 2632 c)(2) UST monitoring system is 2resent (M 1) <br /> I I CCR 2630(d) UST system monitoring equi2mentis_2Lo2erly located to detest a leak (M 1) <br /> 12 1 HSC 25291 1b) UST system monitoring equipment iso2erational (M2) <br /> 13 CCR 2636 1 Continuous monitoring system for underground piping&UDC is 2resent (M 1) <br /> 14 CCR 2631 (a) Primary containment is 2roduct tight <br /> 15 HSC 25291 (a)(2) Secondary containment for UST is tight <br /> 16 CCR 2636 1c)j I) All releases in seconds 2i2inE flow to a collection sum2 <br /> 17 HSC 25291 Line leak detectors are installed (Ml) <br /> 18 CCR 2635 b) I) Spill container (M2) <br /> 19 CCR 2635(b)(2) Overfill 2revention system (M2) <br /> 20 CCR 2636(a) Conventional t <br /> 21 HSC 25291 (e) Water in 2'containment analyzed&proRerIX dis2osed of <br /> 22 CCR 2650 Recording/reporting of unauthorized releases (M 1) <br /> 23 CCR 2715 Designated 02erator:(a)Statement from UST owner; c-e)MonthIX inspection;(t)Em2loXee training <br /> 24 CCR 2638 a) Annual monitorin certification <br /> --25 CCR 2638(a) Annual line leak detector test (M1) <br /> 26 -HSC 25284.2 Annual s2ill containment testin <br /> 27 CCR 2636(D(4) Annual line tightness test (M 1) <br /> 28 CCR 2661 (0 Re air for tank/piping has had tightness test (M2) <br /> 29 CCR 2643(e) Biennial tightness test of gravity 2i2ing(pre-January 1, 1984) <br /> 30 CCR 2643(d) Triennial line test for conventional suction piping(pre-January 1, 1984) (M1) <br /> 31 HSC 25292.5 Double wall system located within 1000'of 2ublic well-ELD <br /> 32 CCR 2661 Permit to re air UST sXstem <br /> 33 HSC 25286(aPermit to alter monitoring sstem <br /> 34 HSC 25298(b) Permit to temeorarily close UST system <br /> 35 HSC 25298(c) Permit to close UST sxstem <br /> 36 HSC 25299(a)(9) Disabling leak detection devices <br /> 37 HSC 25298 ja) Illegal abandonment of UST sXstem <br /> 38 Other: <br /> EHD INSPr PHONE: UIC <br /> Septic system: <br /> -Serves�:20 people/day <br /> RECEIVED TITLE: -Receives other than sanitary waste <br /> Of Other disposal methods: <br /> Dry wells/French Drains <br /> EHD 23-02-002 REV 05/07 <br />