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RECEIVED BY: <br />EHD 23-02-002 REV 8/08 <br />Gj-6 Septic system: <br />r t� ❑ Serves Z20 people/day <br />TITLE: ' ❑ Receives other than sanitary waste <br />I ►1 <br />Other disposal methods: <br />❑_Dry wells/French Drains <br />SAN JOAQUIN COUNTY <br />NVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, California 95202-3029 <br />' <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.si4ov.or /q ehd <br />UNDERGROUND STORAGE TANK UST PROGRAM INSPECTION REPORT <br />Facility name: <br />Designated Operator: <br />Inspection <br />kFa2ilityaddress: <br />Date: <br />UST # <br />'Product <br />*— <br />Fa ility Contact: <br />fti <br />Title: Phone: <br />Monitoring Pane <br />(✓-9 3 <br />Piping system: Overfill prevention: <br />essurized ❑ Suction ❑ Gravity echanical ❑ Audible/visual <br />Inspection type: <br />Violations: <br />outine Monitoring Certification ❑ Installation ❑ Other: ❑ M1-RDetect ❑ M2-RPrev <br />❑ M-3 Both <br /># <br />Code Section <br />VIOLATION(S) HSC=Califomia Health & Safety Code; CCR=California Code of Regulations <br />V=Violation; RV=Re eat Violation <br />T <br />1 <br />HSC 25284 <br />Permit too erste <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 b <br />Monitoring Program(Monitoring & Response Plan is current and approved by the local a enc <br />6 <br />CCR 2712 i <br />Monitoring plan is onsite. <br />. <br />7 <br />CCR 2712 b <br />Maintenance & monitoring records <br />M1 <br />8 <br />CCR 2643 d <br />Daily monitoring of suction piping (pre-Janua!y, 1, 1984 <br />9 <br />HSC 25292.1 <br />UST system is -operated to prevent unauthorized release <br />10 <br />CCR 2632 (c)(2) <br />UST monitoring system is present <br />(M1) <br />11 <br />CCR 2630 d <br />UST system monitoring equipment is properly located to detect a leak <br />M1 ll <br />12 <br />HSC 25291 b <br />UST system monitoring equipment is operational <br />(M1 <br />13 <br />CCR 2636 1 <br />Continuous monitoringsystem for under round piping & UDC is resent <br />M1 <br />14 <br />CCR 2631 a <br />Primary containment is product tight <br />15 <br />HSC 25291 (a)(2) <br />Secondary containment for UST is ti ht <br />16 <br />CCR 2636 (c)(1) <br />All releases in secondary pipingflow to a collection sum <br />17 <br />HSC 25291 <br />Line leak detectors are installed <br />M1 <br />18 <br />CCR 2635 (b)(1) <br />Spill container <br />M2 <br />19 <br />CCR 2635 (b)(2) <br />Overrill prevention system <br />M2 <br />20 <br />CCR 2636 (a) <br />Conventional suction piping shall have continuous monitoring & 20 containment <br />21 <br />HSC 25291 (e) <br />Water in 20 containment analyzed & properly disposed of <br />22 <br />CCR 2650 <br />Recording/reporting of unauthorized releases <br />M1 <br />23 <br />CCR 2715 <br />Designated Operator: a Statement from UST owner; (c -e) Monthly inspection; Employee <br />24 <br />CCR 2638 a <br />-training <br />Annual monitoring certification <br />25 <br />CCR 2638 a <br />Annual line leak detector test <br />M1 <br />26 <br />HSC 25284.2 <br />Annuals ill containment testing <br />27 <br />CCR 2636 4 <br />Annual line tightness test <br />M1 <br />28 <br />CCR 2661 <br />Repair for tank/piping has had tightness test <br />(M2) <br />29 <br />CCR 2643 a <br />Biennial ti htness test of gravity piping(pre-January 1, 1984 <br />30 <br />CCR 2643 d <br />Triennial line test for conventional suction piping re -January 1, 1984) <br />(M1) <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 <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 <br />Disabling leak detection devices <br />a 9 2 <br />37 <br />HSC 25298 a <br />Illegal abandonment of UST s stem <br />38 <br />Other: <br />RECEIVED BY: <br />EHD 23-02-002 REV 8/08 <br />Gj-6 Septic system: <br />r t� ❑ Serves Z20 people/day <br />TITLE: ' ❑ Receives other than sanitary waste <br />I ►1 <br />Other disposal methods: <br />❑_Dry wells/French Drains <br />