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SAN JOAQUIN COUNTY <br /> VIENVIRONMENTAL HEALTH DEPAR.TM <br /> 600 East Win Street, Stockton,California 95202,.,29 <br /> Telephone:(209)468-3420 Fax.(209)468-3433 Web:www.sigov.org/ehd <br /> UNDERGROUND STORAGE TANK USTJ PROGRAM INSPECTION REPORT <br /> Facility name: Designated ORerator: Inspection <br /> Date: <br /> Facility address: r UST#.,� t A, .• P �/u l <br /> v' <br /> 'Product. <br /> Facilitv Contact* Title: Phone: (,¢ <br /> 04 <br /> R <br /> ring Panel- Piping system: rfill prevention: <br /> Pressurized ❑Suction ❑Gravityechariical ❑Audiblelvisual <br /> Inspection type: Violations: <br /> ❑Routine ❑Monitoring Certification ❑Installation ❑Other. 1-RDetect ❑M2-RPrev ❑M-3 Both <br /> # Code Section VIOLATION(S) HSC=California Health&Safety Code;CO=California Code of Regulations V R <br /> V=Violation;RV=Re eat Violation V <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 /> 4 HSC 25292.2 Certification of financial responsibility and CFO letter <br /> 5 CCR 2632 b Monitoring Program(Monitoring&Response Plan is current and approved by the local a enc . <br /> 6 CCR 2712 1 Monitoring Ian 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 HSC 25292.1 UST system iso erated to prevent unauthorized release <br /> 10 CCR 2632(c)(2) UST monitoring system is present M1 <br /> 11 CCR 2630 d UST system monitoring equipment is properly located to detect a leak M1 <br /> 12 HSC 25291 b UST system monitoring equipment isoperational M1or -74 <br /> 13 CCR 2636 1 Continuous monitoring system for underground pi.ping&UDC is prese2t M1 <br /> 14 CCR 2631 a Prima containment is product tight <br /> 15 HSC 25291 (a)(2) Secondary containment for UST is tight <br /> 16 1 CCR 2636(c)(1) All releases in secondary pipingflow to a collection sum <br /> 17 HSC 25291 Line leak detectors are installed M1 <br /> 18 CCR 2635(b)(1) Spill container (M2 <br /> 19 CCR 2635(b)(2) Overfill prevention system M2 <br /> 20 CCR 2636(a) Conventional suction piping shall have continuous monitoring&20 containment <br /> 21 HSC 25291 (e) Water in 20 containment analyzed&properly disp2sed of <br /> 22 CCR 2650 Recording/reporting of unauthorized releases M1 <br /> 123 CCR 2715 Designated Operator: a Statement from UST owner; (c-e)Monthly inspectioninspectioni 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 fi htness test M1 <br /> 28 CCR 2661 Repair for tank/piping has had tightness test M2 <br /> 29 CCR 2643 a Biennial tightness test of gravity piping(pre-January 1,-1984) <br /> 30 CCR 2643 d Triennial line test for conventional suction piping re-January 1, 1984) M1 <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 Disabling leak detection devices <br /> a 9 2 <br /> 37 HSC 25298 a Illegal abandonment of UST system <br /> 38 Other: <br /> EHD IN PECT R: POE: UIC <br /> Septic system: <br /> 4 ❑Serves z20 people/day <br /> RECE E BY: TITLE: ❑Receives other than sanitary waste <br /> Other disposal methods: <br /> i" ❑Dry wells/French Drains <br /> EHD 23-02-002 REV 8/08 <br />