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A- SAN JOAQUIN COUNTY <br />VIRONMENTAL HEALTH DEPARTMENIS <br />304 East Weber Avenue, P Floor, Stockton, CA 95202-2708 <br />Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: www.sjgov.org/ehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAM <br />INSPECTION REPORT <br />Facility name: <br />I <br />HSC 25284 <br />Designated Operator: Inspection Date: <br />QVICAC N C-&iyG <br />2 <br />CCR 2637 <br />L%j L 6 r -J I INA M 0 31 -A-7 /0 & <br />Facility address: <br />3 <br />CCR 2711 (b) & (c) <br />UST# <br />4. <br />kqo —(1116 e^to SITOFST <br />Certification of financial responsibility and CFO letter <br />Product <br />CCR 2632 (c)(2)(DL_ <br />Facility Contact: Title: <br />Phone: <br />6 1 <br />CCR 2712 (i) <br />Monitorin & response plan is onsite <br />11f4ef- <br />(MDwKmhi> MATV— 011f4 <br />j <br />���-2Gt�i <br />Maintenance & monitoring records <br />(Mi) <br />Monitoring Panel: <br />Monitoring <br />Piping system: <br />Daily monitoring of suction piping (pre -January, 1, 1984) <br />Overfill prevention: <br />V k ' 111 GWressurized <br />11 Suction <br />El Gravity <br />10 <br />echanical 11 Audible/visual <br />Inspection type: <br />(Mi) <br />11 <br />Violations: <br />RRoutine Monitoring Certification 11 Installation <br />El Other: <br />12 <br />11 M I -RDetect 11 M2-RPrev 1 M-3 Both <br /># <br />I <br />Code Section <br />VIOLATION(S) HSC=Califomia Health & Safety Code; CCR=Califomia Code of Regulations V R <br />V=Violation; RV=Repeat Violation V <br />I <br />HSC 25284 <br />Permit to operate <br />2 <br />CCR 2637 <br />Secondary containment test Rerformed <br />3 <br />CCR 2711 (b) & (c) <br />Current Unified Program Consolidated Forms on file with EHD (Facility and tank form) <br />HSC 25292.2 <br />Certification of financial responsibility and CFO letter <br />5 <br />CCR 2632 (c)(2)(DL_ <br />Monitoring & response plan is current and filed with the local agency <br />6 1 <br />CCR 2712 (i) <br />Monitorin & response plan is onsite <br />7 <br />CCR 2712 (b) <br />Maintenance & monitoring records <br />(Mi) <br />8 <br />CCR 2643'(d) <br />Daily monitoring of suction piping (pre -January, 1, 1984) <br />9 <br />HSC 25292.1 <br />UST system isoperated to prevent unauthorized release <br />10 <br />CCR 2632 (c)(2) <br />UST monitoring system is present <br />(Mi) <br />11 <br />CCR 2630 (d) <br />UST system monitoring equiRment is properly located to detect a leak <br />(Mi) <br />12 <br />HSC 25291 (b) <br />UST systern monitoring Equipment is operational <br />(M2) <br />13 <br />CCR 2636 (f)(1) <br />Continuous monitoring system for underground pi2ing & UDC is present <br />(Mi) <br />14 <br />CCR 2631'-(a) <br />Primary containment is goduct tight <br />15 <br />HSC 25291 (a X2) <br />Seconds containment for UST is tight <br />16 <br />17 <br />CCR 2636;(c)(1) <br />HSC 25291 (9 <br />All releases in second n piping flow to4,collection sump <br />Line leak detector(s) are installed <br />(MI) <br />18 <br />CCR 2635 (b)(1) <br />Spill container <br />(M2) <br />19 <br />CCR 2635 (b)(2) <br />Overfill prevention system <br />(M2) <br />20 <br />CCR 2636 (a) <br />Conventional suction piping shall have continuous monij n2tl & 21 containment <br />21 <br />HSC 25291 (e) <br />Water in 2' containment analyzed & properly disposed of <br />122 <br />CCR 2650 <br />Rec2jqj!jre orting of unauthorized releases <br />(Mi) <br />23 <br />CCR 2715 <br />Desioated Operator: 0 Statement from UST owner; c-eMonthly ins ection; <br />EMgloyee training <br />24 1 <br />CCR 2638 (a) <br />Annual monitoring certification <br />25 <br />CCR 2638 (a) <br />Annual line leak detector test <br />(Mi� <br />26 <br />27 <br />HSC 15284.2 <br />CCR 2636 4) <br />Annual spill containment testing <br />Annual line tightness test <br />(Mi) <br />28 <br />CCR 2661 (n <br />BMair for tantJpjting has had tightness test <br />(N[2) <br />29 <br />CCR 2643 e <br />Biennial tightness test of gravity pi2ing (pre -January 1, 1984) <br />30 1 <br />CCR 2643 (d) <br />Triennial line test for conventional suction 2!pm (pre -January 1, 19E <br />Lj <br />(Mi) <br />31 <br />HSC 25292.5 <br />_ <br />Double wall system located within 1000' of 2ublic well-ELD <br />32 <br />CCR 2661 <br />Permit to repair UST system <br />33 <br />HSC 25286 (a) <br />Permit to alter monitoring system <br />34 <br />HSC 25298 <br />Permit to tem aril close UST s)LsLem <br />35 <br />HSC 25298 (c) <br />Permit to close UST system <br />-36 1 <br />HSC 25299 (a)(9) <br />Disabling leak detection devices <br />37 <br />HSC 25298 (a) <br />Illegal abandonment of UST system <br />38 1 <br />Other: <br />EHD INSPECTOR: <br />RECEI 1 <br />PHONE: <br />Z -(OF- <br />TITLE: <br />UIC <br />Septic system: <br />G Serves �!20 people/day <br />0 Receives other than sanitary waste <br />Other disposal methods: <br />El Dry wells/French Drains <br />EHD 23-02-002 <br />