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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.sigov.or <br /> UNDERGROUND (UST) PROGRAM INSPECTION E <br /> Facility nam ` D g at d Operator: Insp coffn <br /> tio Date: <br /> (L <br /> Facilitadd ss: pp UST# 1 , <br /> Product <br /> Fa '1' � ContTRA Phone: <br /> y <br /> lk <br /> M 'to ing Piping system: Overfill prevention: <br /> 19 ressurized ❑Suction ❑Gravity Mechanical ❑Audible/visual <br /> In,spection type: violations: <br /> Routine ❑Monitoring Certification ❑Installation ❑Other: ❑MI-RDetect ❑M2-RPrev ❑M-3 Both <br /> VIOLATION(S) HSC=California Health&Safety Code;CCR=California Code of Regulations I <br /> # Code Section <br /> V=Violation;RV=Re eat Violation V <br /> I HSC 25284 Permit to o erate <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 i) Monitoring Ian is onsite. <br /> 7 CCR 2712 b Maintenance&monitoring records fl <br /> 8 CCR 2643 d) Daily monitoring of suction piping(pre-Janu2a, 1, 1984) <br /> 9 1 HSC 25292.1 UST system isoperated to prevent unauthorized release <br /> 10 CCR 2632 c)2) UST monitorin system is 2resent (M 1) <br /> 11 CCR 2630 d UST s stem monitorin e ui ment is properly located to detect a leak M 0 <br /> 12 HSC 25291 b) UST s stem monitoring equipment isoperational (M2) <br /> 13 CCR 2636 l Continuous monitoring system for underground i2ing&UDC is 2resent M1 <br /> 14 CCR 2631 a) Primaa containment is product tight <br /> 15 HSC 25291 (a)(2) Secondary containment for UST is ti ht <br /> 16 CCR 2636 c 1 All releases in see)ndaC/Eiping flow 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 i in shall have continuous monitorin &2°containment <br /> 21 HSC 25291 (e) Water in 2°containment analyzed&pro erly disposed of <br /> 22 CCR 2650 Recordin /re ortin of unauthorized releases (M1) <br /> 23 CCR 2715 Designated Operator:(a)Statement from UST owns , (c-e)Month( ins ection;(f)Em to ee trainin <br /> 24 CCR 2638 a Annual monitoring certification <br /> 25 CCR 2638(a) Annual line leak detector test (M1) <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636(f)(4) Annual line tightness test M 1) <br /> 28 CCR 2661 (f) Re air for tank/piping has had tightness test (N12) <br /> 29 CCR 2643 a Biennial tightness test of ravity piping(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 walls stem located within 1000'of ublic well-ELD <br /> 32 CCR 2661 Permit to repair UST system <br /> 33 HSC 25286 a) Permit to alter monitorinE system <br /> 34 HSC 25298 b) Permit to tem.porarilv 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 /> ED <br /> INS CT P ON Ult <br /> �' / Sentic system: <br /> Serves>_20 people/day <br /> RE EIVED B� t TITLE: —Receives other than sanitary waste <br /> Other disposal methods: <br /> Dry wells/French Drains <br /> EHD 23-02-002 REV 05/07 <br />