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AN JOAUIN 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.siQov.or /g ehd <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION T <br /> Facility name: Designated Operator: Inspection <br /> Date: _ <br /> A -T'10 -, Ck (� MA / a i 5 r3 <br /> Facility address: UST# �, <br /> 120 SkI <br /> Product <br /> Facility Contact: Title: Phone: <br /> Monitoring Panel: Piping system: toy,O® Ov ;II prevention: t <br /> Pressurized ❑Suction Gravity ec�iaA I Audible/visual 0 4 <br /> Inspection type: Violations: <br /> Routine Monitoring Certification ❑Installation ❑Other: 1-RDetect ❑M2-RPrev ❑M-3 Both <br /> VIOLATION(S) HSC=Califor 'a Health& fety Code;CCR=California Code of Regulations V R <br /> Code Section V <br /> Violation; V 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 /> 4 HSC 25292.2 Certification of financial responsibility and CFO letter <br /> 5- CCR 2632 b Monitoring Program(Monitoring&Response Plan is current and a22roved by the local agency. <br /> 6 CCR 2712 i Monitoring Ian is onsite. <br /> 7 CCR 2712 b Maintenance&monitoring records <br /> 8 CCR 2643 d Daily monitorin of suction eieing (pre-January, 1, 1984 <br /> 9 HSC 25292.1 UST system iso erated to erevent unauthorized release <br /> 10 CCR 2632(c)(2) UST monitoring system is present 1 <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 is operational (M1) <br /> 13. CCR 2636 1 Continuous monitoring system for underground piping&UDC is present M1 <br /> 14 CCR 2631 a Primary containment is eroduct tight <br /> 15 HSC 25291 (a)(2) Seconda containment for UST is tight <br /> 16 CCR 2636(c)(1) All releases in seconds piping flow to a collection sum <br /> 17 HSC 25291 Line leak detectors are installed 1 <br /> 18 CCR 2635(b)(1) Spill container (M2) <br /> 19 1CCR 2635(b)(2) Overfill prevention system (M2) <br /> 20 CCR 2636(a) Conventional suction p!pin shall have continuous monitoring&20 containment <br /> 21 HSC 25291 (e) Walffin 20 containment analyzed&properly disposed of <br /> 22 CCR 2650 (Recordorepa4igg of unauthorized releases ( 1 <br /> 23 CCR 2715 Desi nated O erator: a Statement from UST owner; (c-eLM2nthly ins ection; Em to Lee trainin <br /> 24 CCR 2638 a Annual monitoring certification <br /> 25 CCR 2638 a Annual line leak detector test ( 1 <br /> 26 HSC 25284.2 Annuals ill containment testin <br /> 27 CCR 2636 4 Annual line tightness test (M1 <br /> 28 CCR 2661 Repair for tank/piping has had tightness test (M2) <br /> 29 CCR 2643 e Biennial tightness test of gravity pipin1984) <br /> 30 CCR 2643 d Triennial line test for conventional suction piping(pre-Janua 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)(f)(2) <br /> 37 1 HSC 25298 a Ille al abandonment of UST system <br /> 38 Other: <br /> EHD INS TO PHONE: UIC <br /> Septicsystem: <br /> 0 Serves 220 people/day <br /> RECEIVED Y:4, <br /> TITLE: 0 Receives other than sanitary waste <br /> Other disposal methods: <br /> d pg 0 Da wells/French Drains <br /> EHD 23-02-002 REV 8/08 UST INSPECTION FINAL <br />