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SAN JOAQUIN COUNTY <br /> a <br /> ONVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3rd Floor,Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sJ og v.or <br /> UNDERGROUND STORAGE TANK(USTI PROGRAM INSPECTION REPORT <br /> Facility name: Designated 0 101 <br /> _N11yerator: Ins ecct�ion Date: <br /> t j Alli A YI �1� 1 <br /> Facility address: UST#1141 Jrh B <br /> • Product <br /> Faci'ty on act: Title: Phone: <br /> Min IV dal Dmnv <br /> it ing Panel: Piping system: f Overfill prevention: <br /> Pressurized ❑Suction ❑Gravity Mechanical ❑Audible/visual <br /> Inspection type: Violations: <br /> Routine ❑Monitoring Certification ❑Installation ❑Other: ❑M1-RDetect ❑M2-RPrev ❑M-3 Both <br /> VIOLATIONS)HSC=California Health&Safety Code;CCR=California Code of Regulations V R <br /> # Code Section V <br /> V=Violation;RV=Re eat Violation <br /> I HSC 25284 Permit tooperate <br /> 2 CCR 2637 Secondary containment test performed <br /> 3 CCR 2711 b & c Current Unified Pro am Consolidated Forms on file with EHD(Facility and tank form <br /> 4 HSC 25292.2 Certification of financial responsibility and CFO letter <br /> 5 CCR 2632 c 2)(D) Monitoring&res onse plan is current and filed with the local a enc <br /> 6 CCR 2712 i Monitoring&response plan is onsite <br /> 7 CCR 2712 Maintenance&monitoring records Ml <br /> 8 CCR 2643 d Daily monitoring of suction Liping(pre-January, 1,1984 <br /> 9 HSC 25292.1 UST system iso erated to prevent unauthorized release <br /> 10 CCR 2632 c 2 UST monitoring system is present Ml <br /> I 1 CCR 2630 d UST system monitoring equipment is properly located to detect a leak MI <br /> 12 HSC 25291 UST system monitoring equipment isoperational M2 <br /> 13 CCR 2636 1 Continuous monitorinE system for underground pi2ing&UDC is present Ml <br /> 14 CCR 2631 a Primary containment is product tight <br /> 15 HSC 25291 a(2) Secondary containment for UST is tight <br /> 16 CCR 2636(c)(1) All releases in secondary ni:ping flow to a collection sum <br /> 17 HSC 25291 Line leak detectors are installed MI <br /> 18 CCR 2635 1 Spill container (M2 <br /> 19 CCR 2635 b 2 Overfill revention system M2 <br /> 20 CCR 2636(a) Conventional suction pj:Ring shall have continuous monitorin' &21 containment <br /> 21 HSC 25291 (e) Water in 2°containment analyzed&properly disposed of <br /> 22 CCR 2650 Recordin` EMorting of unauthorized releases Ml <br /> 23 CCR 2715 DesignatedOperator: a Statement from UST owner; (c-e)Monthly inspection; Employee trainin <br /> 24 CCR 2638 a Annual monitoring" certification <br /> 25 CCR 2638 a Annual line leak detector test Ml <br /> 26 HSC 25284.2 Annual spjll containment testing <br /> 27 CCR 2636 4 Annual line ti htness test Ml <br /> 28 1 CCR 2661 Repair for tank! i ing has had tightness test (M2 <br /> 29 CCR 2643 e Biennial ti htness test of Eavity 2ipingre-Janus 1, 1984 <br /> 30 CCR 2643 d Triennial line test for conventionalsuction piping(pre-JanuTj1,1984 Ml <br /> 31 HSC 25292.5 Double walls stem located within 1000'of public well-ELD <br /> 32 CCR 2661 Permit to re air UST s stem <br /> 33 HSC 25286 a Permit to alter monitoring system <br /> 34 HSC 25298 Permit totemporarily close UST system <br /> 35 HSC 25298 c Permit to close UST system <br /> 36 HSC 25299(a)(9) Disabling leak detection devices <br /> 37 HSC 25298 a) Illegal abandonment of UST system <br /> 38 Other <br /> IEHU INS ECTOR: PHONE: UIC <br /> Septic system: <br /> NO n. I IA,—') W, ®�'1 ]Serves>_20 people/day <br /> ItECEIVE11)BY TITLE: Receives other than sanitary waste <br /> <J�! Other disposal methods: <br /> E Dry wells/French Drains <br /> EHD 23-02-002 <br />