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SAN JOAQUIN COUNTY <br /> VIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3`d Floor, Stockton,CA 9520208 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sigov.org/ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> C,kt,l wF t rA vmP p(L'tx `5ftQ M 2.2,1.0('0 <br /> Facility address: UST# 2 <br /> 2,22q MA0TgC-q zp 1 + 3 MLo <br /> Product <br /> Facility Contact: Title: Phone: <br /> tiAtiol ve X161-_7 to2-1 <br /> °Monitoring Panel: Piping system: fill prevention: <br /> V — T1 350 Pressurized 11 Suction El Gravity <br /> Gravity Mechanical ❑Audible/visual <br /> Inspection type: Violations: <br /> outine onitoring Certification ❑Installation ❑Other: Ml-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 /> 1 HSC 25284 Permit tooperate <br /> 2 CCR 2637 Secondary containment test_performed <br /> 3 CCR 2711 b & c Current Unified Program Consolidated Forms on file with EHD(Facility and tank form <br /> 4rrr HSC 25292.2 i' Certification of financial responsibility and CFO letter <br /> 5 CCR 2632 c 2)(D) Monitoring&response plan is current and filed with the local agency <br /> 6 CCR 2712(i) Monitoring&response plan is onsite <br /> 7 CCR 2712 b Maintenance&monitoring records M1 <br /> 8 CCR 2643(d) Daily monitoring of suction piping(pre-January, 1,1984)' <br /> 9 1 HSC 25292.1 UST system isoperated to prevent unauthorized release <br /> 10 CCR 2632(c)(2) UST monitoring system is present MI <br /> 11 CCR 2630(d) UST system monitoring equipment is properly located to detect a leak Ml <br /> 12 HSC 25291 UST system monitoring equipment is operational M2 <br /> 13 CCR 2636(f)(1) Continuous monitoring system for underground piping&UDC is present (MI) <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 pipingflow to a collection sum <br /> 17 HSC 25291 ( Line leak detectors are installed (Mi) <br /> 18 CCR 2635,,(b)(1) Sill container (M2) <br /> 19 CCR 2635(b)(2) Overfill prevention system M2 <br /> 20 CCR 2636(a) Conventional suction piping shall have continuous monitoring&2°containment <br /> 21 HSC 25291 (e) Water in 2°containment analyzed&properly disposed of <br /> 22 1 CCR 2650 Recording/reporting of unauthorized releases "Ml <br /> 23 CCR 2715 Designated Operator:(a)Statement from UST owner; (c-e)Monthly inspection;(f)Employee training <br /> 24 CCR 2638 a Annual monitoring certification <br /> 25 CCR 2638(a) Annual line leak detector test (M1) <br /> 26 HSC 25284.2 Annual spill containment testing <br /> 27 CCR 2636 (4) Annual line tightness test MI <br /> 2$ 1 CCR 2661'fj Repair for tank/piping has had tightness test M2 <br /> 29 CCR 2643 e Biennial tightness test of gravity piping( re-Janus 1, 1984 <br /> 30 CCR 2643(d) Triennial line test for conventional suction piping( re-Jams 1,1984) (MI) <br /> 31 HSC 25292.5 Double walls stem located within 1000'of public well-ELD <br /> 32 CCR 2661 Permit to repair UST system <br /> 33 HSC 25286 a) Permit to alter monitoring system <br /> 34 HSC 25298(b) Permit to temporarily close UST system <br /> 35 HSC 25298 c Permit to close UST system <br /> 36 HSC 25299(a)(9)rr Disabling leak detection devices <br /> 37 HSC 25298 (a)Illegal abandonment of UST system <br /> 38 Other: <br /> EHD INSPECTOR: PHONE: UIC <br /> Vj I �� .1 ,-'7'� Septic system: <br /> RECEIVED BY:.` "l Serves>_20 people/day <br /> TITLE: ❑Receives other than sanitary waste <br /> IMI.1�„L Other disposal methods: <br /> wells/French Drains <br /> EHD 23-02-002 <br /> I <br />