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SAN JOAQUIN COUNTY <br /> IRONMENTALHEALTH DEPARTMENT <br /> 304 East eber Avenue, 3dFloor, Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sj og v.or /g ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> Facility address: UST# <br /> Product <br /> Facility Contact: Title: Phone: <br /> &-t t l 20`1 Lf("(- 163 <br /> Monitoring Panel: Piping stem: Overfill prevention: <br /> fedL.- I L.Kessurized ❑Suction ❑Gravity l;-We hanical ❑Audible/visual <br /> I�nspec�t' n type: Violations: <br /> Ld�outineonitoring Certification ❑Installation ❑Other: ❑MI-RDetect ❑M2-RPrev ❑M-3 Both <br /> VIOLATION(S) HSC=California Health&Safety Code;CCR=California Code of Regulations V R <br /> # Code Section <br /> V=Violation;RV=Re eat Violation V <br /> I 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 Certificationof 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 Ml <br /> 8 CCR 2643(d) Daily monitoring of suction piping(pre-January, 1, 1984) <br /> 9 HSC 25292.1 UST system isoperated to prevent unauthorized release <br /> 10 CCR 2632(c)(2) UST monitoring system is present Mi <br /> I I CCR 2630(d) UST system monitoring equipment is properly located to detect a leak (MI) <br /> 12 HSC 25291 UST system monitoring equipment isoperational M2 <br /> 13 CCR 2636 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 sump <br /> 17 HSC 25291 ( Line leak detectors are installed (MI) <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&2°containment <br /> 21 HSC 25291 (e) Water in 2°containment analyzed&properly disposed of <br /> 22 CCR 2650 Recording/reporting of unauthorized releases Mi <br /> 23 CCR 2715 Designated Operator:(a)Statement from UST owner; (c-e)Monthly inspection;(f)Employee trainin <br /> 24 1 CCR 2638 a Annual monitoring certification <br /> 25 CCR 2638(a) Annual line leak detector test (Ml) <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636 0(4) Annual line tightness test Ml <br /> 28 CCR 2661 f) Repair for tank/piping has had tightness test (M2) <br /> 29 CCR 2643 e Biennial tightness test of gravity piping( re-Januar 1, 1984 <br /> 30 CCR 2643 d Triennial line test for conventional suction piping(pre-January I,1984) (M1 <br /> 31 HSC 25292.5 Double walls stem located within 1000'of ublic well-ELD 01 <br /> 32 CCR 2661 Permit to repair UST system CAA4.e. LD Zoo D q1 57 _M-li <br /> 33 HSC 25286(a) Permit to alter monitoring system <br /> 34 HSC 25298 Permit to temporarily 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 /> EHD INSPECT R: PHONE: UIC <br /> �Q C/0 Septic system: <br /> l-� ❑Serves>_20 people/day <br /> RECE D BY: TITL 11Receives other than sanitary waste <br /> C � t pn TC-- ;�Q Other disposal methods: <br /> /�C we]Is/French Drains <br /> L Zoo G <br /> 8"7 0'5 1310 C-5-0 6 lSo 6 <br /> EHD 23-02-002 <br /> r3"5 L n 2 o-C ST'p�(� <br />