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P <. C HEALTH SERVICES SAN JOAQ COUNTY DATE O/ <br />PR# '2.31310 <br />ENVIRONMENTAL' HEALTH DIVISION 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 NameIx 0,71 /( c Facility Address 351 t4 -c , <br />I -Pr-+ <br />IxeFacilty Contactl?Aa TF, Title Q Phone # -la l'T"_ <br />ofd R <br />UST# 5 Product 1DuF_,2 UST##Product USTProduct UST#Product <br />Overfill Prevention: Audible/Visual echanical Monitoring Panel: R14r* <br />Piping System: Gravity Pressur uc ion Violations: i Ma or <br />Automatic Pump Shut Down Satis ): Yes No Dispenser Pan: Yes o <br />INSPECTION TYPE:cutin Monitoring Certificatiorrj Complaint Install Removal Repair/Upgrade <br />COMPANY NAME:TECHNICIAN NAME: Al M i 110 U rr-) PHONE Cb <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 <br />HSC 25284 <br />Permit to operate <br />2 <br />CCR 2637 <br />Secondary cont testing (6 <br />20 <br />CCR 2712 (b) <br />month/36 month) <br />3 <br />CCR 2711(b) & (c) Current State Forms A & B <br />4 <br />HSC 25292.2 <br />Certification of financial <br />Annual line tightness test <br />22 <br />responsibility and letter from <br />Annual line leak detector test <br />23 <br />chief financial officer <br />5 <br />CCR 2630 (d) <br />Continuous monitoring <br />certification <br />24 <br />system for UST system <br />6 <br />CCR 2636 (c)(1) <br />All releases in secondary <br />piping that is not <br />piping flow to a collection <br />continuously monitored <br />25 <br />sump <br />7 <br />HSC 25291 (e) <br />Water in secondary (20) cont <br />8 <br />HSC 25291 (f) <br />Automatic line leak <br />continuously monitored <br />26 <br />detector(s) <br />9 <br />CCR 2636 (f)(1) <br />Continuous monitoring <br />gravity piping that is not <br />system for underground <br />continuously monitored <br />27 <br />piping <br />10 <br />CCR 2632 (c)(2) <br />Continuous monitoring <br />UST system <br />28 <br />system for UST <br />11 <br />HSC 25291(a)(2) <br />Secondary containment for <br />Permit to alter monitoring <br />UST is tight <br />12 <br />CCR 2636 (f)(1) <br />Continuous monitoring <br />Illegal abandonment of UST <br />system for dispenser system <br />13 <br />CCR 2635 (b)(1) <br />Spill container <br />14 <br />CCR 2635 (b)(2) <br />Overfill prevention system <br />15 <br />CCR 2631 (a) <br />Primary containment is <br />Permit to close UST system <br />33 <br />product -tight <br />16 <br />HSC 25292.1 <br />UST system is operated to <br />and properly disposed of <br />34 <br />prevent unauthorized release <br />17 <br />CCR 2650 <br />Recording/reporting <br />1000' of Public Well, no ELD <br />36 <br />unauthorized release <br />18 <br />CCR 2632 (d) <br />Monitoring & response plan <br />EHD INSPECTOR: <br />UNITIIUUST/INSP (rev 12/19/01) <br />19 <br />CCR 2712 (i) <br />Monitoring & response plan <br />is on site <br />20 <br />CCR 2712 (b) <br />Maintenance & monitoring <br />records <br />21 <br />CCR 2636 (f)(4) <br />Annual line tightness test <br />22 <br />CCR 2630 (d) <br />Annual line leak detector test <br />23 <br />CCR 2630 (d) <br />Annual monitoring <br />certification <br />24 <br />CCR 2643 (d) <br />Daily monitoring of suction <br />piping that is not <br />continuously monitored <br />25 <br />CCR 2643 (d) <br />Triennial tightness test of <br />suction piping that is not <br />continuously monitored <br />26 <br />CCR 2643 (e) <br />Biennial tightness test of <br />gravity piping that is not <br />continuously monitored <br />27 <br />CCR 2662 <br />Upgrade requirements for <br />UST system <br />28 <br />CCR 2661 <br />Permit to repair UST system <br />29 <br />HSC 25286 (a) <br />Permit to alter monitoring <br />system <br />30 <br />HSC 25298 (a) <br />Illegal abandonment of UST <br />system <br />31 <br />HSC 25298 (b) <br />Permit to temporarily close <br />UST system <br />32 <br />HSC 25298 (c) <br />Permit to close UST system <br />33 <br />HSC 25291 (e) <br />Water in 20 cont analyzed <br />and properly disposed of <br />34 <br />CCR 2640 (e) <br />Single wall component within <br />1000' of Public Well, no ELD <br />36 <br />CCR 2635(a)(2)(A) Cathodic protection testing <br />35 <br />Violation(s) not listed above <br />• 11"Ma <br />