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00 SAN JOAQUIN COUNTY PTE <br /> ENVIRONMENTAL HEALTH DEPARTMENT PAGE <br /> 304 E. Weber Ave., Third Floor, Stockton, CA 95202 <br /> (209)468-3420 <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility Name O, Facility Address_ <br /> Facilty Contact Title Z Phone# <br /> UST# Product' UST#�Product_ UST# roductUST# Product <br /> Overfill Prevention: )IAudible/Visual ❑ Mechanical Monitoring Panel: (5;0310 a EAU <br /> Piping System: ❑Gravity VLPressure ❑ Suction Violations: ❑ M1-RDet ❑ M2-Rprev ❑ M3-Both <br /> Automatic Pump Shut Down Satisfies CCR 2636 5): XYes ❑ No Designated Operator: <br /> INSPECTION TYPE: XRoutine nitoring Certification ❑Complaint ❑Install []Removal ❑Repair/Upgrade <br /> COMPANY NAME: TECHNICIAN NAME: PHONE: <br /> VIOLATION(S) <br /> The above facility is not in compliance with the following section(s) of Health & Safety Code (HSC) and/or <br /> California Code of Regulations (CCR): <br /> 1 HSC 25284 Permit to operate 23 CCR 2643 (d) Daily monitoring of suction <br /> 2 CCR 2637 Secondary cont. testing piping (pre-1/1/84) <br /> 3 CCR 2711(b) & (c) Current State Forms A& B 24 CCR 2636 (a) Conventional suction piping <br /> 4 HSC 25292.2 Certification of financial shall have continuous <br /> responsibility& CFO letter monitoring &20 containment <br /> 5 CCR 2632 (c)(2) UST monitoring is present(M1) 25 CCR 2643 (e) Biennial tightness test of gravit,. <br /> 6 CCR 2630 (d) UST system monitoring piping (pre-1/1/84) <br /> equipment is properly located to 26 CCR 2643 (d) Triennial line test for <br /> detect a leak (M1) conventional suction (pre- <br /> 7 CCR 2637(b) UST system monitoring 1/1/84)(M1) <br /> equipment is operational (M1) 27 CCR 2662 1998 upgrade of UST system <br /> 8 CCR 2636 (f)(1) Continuous monitoring system 28 CCR 2661 Permit to repair UST system <br /> for underground piping & UDC 29 HSC 25286 (a) Permit to alter monitoring <br /> is present(M1) system <br /> 9 CCR 2636 (c)(1) All releases in secondary piping 30 HSC 25298 (a) Illegal abandonment of UST <br /> flow to a collection sump system <br /> 10 HSC 25291 (f) Line leak detector(s) (M1) 31 HSC 25298 (b) Permit to temporarily close US- <br /> 11 HSC 25291(a)(2) Secondary containment for system <br /> UST is tight 32 HSC 25298 (c) Permit to close UST system <br /> 12 CCR 2635 (b)(1) Spill container(M2) 33 HSC 25292.1 UST system is operated to <br /> 13 HSC 25284.2 Annual spill container testing prevent unauthorized release <br /> 14 CCR 2635 (b)(2) Overfill prevention system (M2) 34 CCR 2650 Recording/reporting <br /> 15 CCR 2631 (a) Primary containment is product- unauthorized release (M1) <br /> tight 35 HSC 25291 (e) Water in 20 cont analyzed and <br /> 16 CCR 2632 (d) Monitoring & response plan properly disposed of <br /> 17 CCR 2712 (i) Monitoring &response plan is 36 CCR 2640 (e) Single wall component within <br /> on site 1 000' of Public Well, no ELD <br /> 18CCR 2712 (b) Maintenance & monitoring 37 CCR 2635(a)(2)(A)Cathodic protection testing & <br /> records (M1) 60 day inspection log (M2) <br /> 19 CCR 2636 (f)(4) Annual line tightness test 38 H&SC 25299(a)(9)Disabling leak detect. Devices <br /> 20 CCR 2630 (d) Annual line leak detector test 39 CCR 2715(a) Statement from UST owner <br /> (M1) 40 CCR 2715(c) Monthly inspection by D.O, <br /> 21 CCR 2630 (d) Annual monitoring certification 41 CCR 2715 (f) D.O. trained employees <br /> 22 CCR 2661 (f) Repair for tank/piping has had 42 Violation(s) not listed above <br /> tightness test(M2) <br /> EHD INSPECTOR: `11A4004 PHON 9't �— <br /> RECEIVED BY. TITLE: <br /> UNITIII/UST/INSP(rev 7/21/04) <br />