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SAN JOAQUIN COUNTY <br />VIRONMENTAL HEALTH DEPARTMENT <br />304 Eas Weber Avenue, 3rd Floor, Stockton, CA 95202- 08 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org-/ehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br />Facility name: <br />`� <br />Designated Operator: <br />✓ ar <br />Inspection Date: <br />p <br />Facility a dress. I <br />V 5. W f1(4 <br />t <br />UST #1 � <br />Product <br />3 <br />4 <br />Facility Cotact: <br />Me: Phone: <br />nitor' g anel: <br />Piping system: <br />Pressurized ❑ Suction ❑ Gravity <br />Overfill prevention: <br />Mechanical ❑ Audible/visual <br />nspection type:Violations: <br />Routine Monitoring Certification ❑ Installation ❑ Other: <br />❑ MI-RDetect ❑ M2-RPrev <br />M-3 Both <br /># <br />Code Section <br />VIOLATION(S) HSC=California Health & Safety Code; CCR=Califomia Code of Regulations <br />V=Violation; RV=Re eat Violation <br />V R <br />V <br />1 <br />HSC 25284 <br />Permit tooperate <br />,2 <br />CCR 2637 <br />Secondary containment test,performed <br />3 <br />CCR 2711 b & c <br />Current Unified Program Consolidated Forms on file with EHD(Facility and tank form) <br />4 <br />HSC 25292.2 <br />Certification of financial responsibility and CFO letter <br />5 <br />CCR 2632 c 2 D) <br />Monitoring & response plan is current and filed with the local agency <br />6 <br />CCR 2712 (i) <br />Monitoring & response plan is onsite <br />7 <br />CCR 2712 b <br />Maintenance & monitoring records <br />M1 <br />8 <br />CCR 2643'(d) <br />Daily monitoring of suction piping (re -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 equipment is properly located to detect a leak <br />Ml <br />12 <br />HSC 25291 <br />UST system monitoring equipment is operational <br />M2) <br />13 <br />CC9 2636 f)(1) <br />Continuous monitoring system for underground piping & UDC is present <br />Ml <br />14 1 <br />CCR 2631 a) <br />Primary containment is product tight <br />15 <br />HSC 25291 (a)(2) <br />Secondary containment for UST is tight <br />_16 <br />CCR 2636 c)(1) <br />All releases in secondary pipingflow to a collection sum <br />17 <br />HSC 25291 (f) <br />Line leak detectors 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 monitoring & 2° containment <br />21 <br />HSC 25291 (e) <br />Water in 2° containment analyzed & pr22erly disposed of <br />22 <br />CCR 2650 <br />Recordieporting of unauthorizedreleases <br />Mi <br />23 <br />CCR 2715 <br />Designated Operator: (a) Statement from UST owner; (c -c) Monthly inspection; (f) Employee training <br />24 <br />CCR 2638 a <br />Annual monitoring certification <br />25 <br />CCR 2638 (a) <br />Annual line leak detector test <br />(Mi) <br />26 1 <br />HSC 25284.2 <br />Annual spill containment testin <br />27 <br />CCR 2636 (4) <br />Annual line tightness test <br />Ml <br />28 <br />CCR 2661 (_) <br />Repair for tank/piping has had tightness test <br />(M2 <br />29 <br />CCR 2643 (e) <br />Biennial tightness test of gravity pipingre-Januar 1, 1984) <br />30 <br />CCR 2643" d <br />Triennial line test for conventional suction piping (re -Jams 1, 1984) <br />(Ml <br />31 <br />HSC 25292.5 <br />Double walls stem located within 1000' of public 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 1 <br />HSC 25298 (b) <br />Permit to temporarily close UST system <br />35 <br />HSC 25298 (c) <br />Permit to close UST system <br />36 <br />HSC 25299 (a)(9) <br />Disabling leak detection devices <br />37 <br />HSC 25298 a) <br />Illegal abandonment of UST system <br />38 <br />Other: <br />EHD INSPECTOR: <br />V �aIm <br />PHONE: <br />, <br />UIC <br />Septic system: <br />❑ Serves >_20 people/day <br />❑ Receives other than sanitary waste <br />Other disposal methods: <br />❑Dry wells/French Drains <br />RECEIVED <br />TIT <br />f - , <br />d"�w�' �� C <br />FHT) 23-02-002 <br />