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SAN JOAQUIN COUNTY <br />#tNVIRONMENTAL HEALTH DEPARTMENT <br />304 East Weber Avenue, 3,d Floor, Stockton, CA 95212- 708 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAM <br />INSPECTION "PORT <br />Facility name: <br />Designated Operator: Inspection Date: <br />low <br />PC*j <br />Facility address: <br />UST # <br />2 <br />CCR 2637 <br />Secondary containment test performed <br />Product <br />9f <br />e-5 <br />Facility Contact: Title: Phone: <br />........ . .... <br />HSC 25292.2 <br />Certification of financial res onsibility and CFO letter <br />2C,9P 94'9-l&3fr, <br />197 <br />CCR 2632 (c)(2D) <br />Monitoring & res2onse 21an is current and filed with the local agency <br />Monitoring Panel: <br />Piping system: <br />Overfill prevention: <br />jus, - 3 'Z-® �t-- <br />I EXPressurized 0 Suction 11 Gravity <br />ZMechanical 11 Audible/visual <br />Inspection type: <br />Violations: <br />Violations: <br />Routine Aonitoring Certification El Installation 11 Other: <br />El M2-RPrev El M-3 Both <br />VIOLATION(S) HSC=Califomia Health & Safety Code: CCR=Califomia <br />Code of Reizulations I V I R <br />n <br />V{.6 6L V.. <br />V=Violation; RV=Repeat Violation <br />V <br />I <br />HSC 25284 <br />Permit tooperate <br />2 <br />CCR 2637 <br />Secondary containment test performed <br />3 <br />CCR 2711 !2?) & (c) <br />Current Unified Pro am Consolidated Forms on file with EHD (Facility and tank form) <br />4 <br />HSC 25292.2 <br />Certification of financial res onsibility and CFO letter <br />5 <br />CCR 2632 (c)(2D) <br />Monitoring & res2onse 21an 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 />(Ml) V <br />8 <br />CCR 2643Ld) <br />Daily monitoring of suction piRing (pre -January, 1, 1984) <br />9 <br />HSC 25292.1 <br />UST system isol2erated to prevent unauthorized release <br />10 <br />CCR 2632 (c)(2) <br />UST monitoring system is ''resent <br />(Mi) <br />11 <br />CCR 2630 d) <br />UST system monitorinE equipment is properly located to detect a leak <br />(Mi) <br />12 <br />HSC 25291P <br />)_ <br />UST s)Ttem monitorin equipment is operational <br />(M2) <br />13 <br />CCR 2636 (f)(1) <br />Continuous monitoring system for underground 2i2ing & UDC is present <br />(MIL <br />14 <br />CCR 2631 a <br />Primary containment is product tight <br />15 <br />HSC 25291 (a)(2) <br />Secondn containment for UST is tight <br />16 <br />CCR 2636 (c)(1) <br />All releases in second 2a Liping flow to a collection sump <br />17 <br />HSC 25291 (f) <br />Line leak detectorsare installed <br />(MI) <br />18 <br />CCR 2635 (b)(1) <br />Spill container <br />(M2) <br />19 <br />CCR 2635 (b)(2) <br />Overfill 2 evention 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 & pr2perly disposed of <br />22 <br />CCR 2650 <br />RecordinLr2orting of unauthorized releases <br />(Mi) <br />23 <br />CCR 2715 <br />Desioated 2perator: (a) Statement from UST owner; (c -e) Monthly inspection; (f) ETgloyee trainin� <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 <br />27 <br />HSC 25284.2 <br />CCR 2636 (f)(4) <br />Annual Rill containment testing <br />Annual line tightness test <br />(Mi) <br />28 <br />CCR 2661 (f) <br />Repair for !T�Wiping has had ti tress test <br />(M2) <br />29 <br />CCR 2643 (e) <br />Biennial tightness test of Eavity piping (pre -January 1, 1984) <br />30 <br />CCR 2643 (d) <br />Triennial line test for conventional suction 2jl in (pre -January 1, 1984) <br />(Mij <br />31 <br />HSC 25292.5 <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 temporarily close UST system <br />35 <br />HSC 25298 c <br />Permit to close UST system <br />36 <br />-HSC 25299 (a J(9) <br />Disablina leak detection devices <br />37 <br />HSC 25298 (a) <br />Illegal abandonment of UST system <br />38 <br />Other: <br />EHD INSPECTOR: PHONE: <br />AuSel2tic <br />— LOCI lAt6b'!- M. <br />RENIVED BY:k�6 9 <br />ZIEW: <br />UIC <br />system: <br />11 Serves �!20 people/day <br />E Receives other than sanitary waste <br />Other disposal methods: <br />Dry wells/French Drains <br />FHD 23-02-002 <br />