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PUBLIC HEALTH SERVICES SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DIVISION <br />304 E. Weber Ave., Third Floor, Stockton, CA 95202 <br />(209) 468-3420 <br />Facility Namef,00- <br />Facility Address <br />Facilty Contact- y Title Phone No. - <br />Program ID# Number of UST(s) <br />UST# / Product <br />Overfill Prevention: Audible and Visual Mechanical <br />Piping system: Gravity Pressure Suction <br />Monitoring system <br />tENk- <br />Automatic pump shutdown satisfies CCR2636 (g): Yes No <br />VIOLATIONS) <br />The above facility is not in compliance with the following section(s) of Health & Safety Code <br />(HSC) and/or California Code of Regulations (CCR): <br />1 HSC 25284 Permit to operate <br />2 HSC 25292.3 Upgrade compliance certificate/sticker <br />3 7—CCR 2711(b) & (c) Current State Form A & B <br />4 HSC 25292.2 Certification of financial responsibility and letter from chief financial <br />/ officer <br />5 �/ CCR 2630 (d) Continuous monitoring system for UST system <br />6 CCR 2636 (c)(1) <br />All releases in secondary piping flow to a collection sump <br />7CCR <br />2636 (a) <br />Secondary containment for piping is waterproof <br />8 <br />CCR 2636 (f)(2) <br />Automatic line leak detector(s) <br />9 4 <br />CCR 2636 (f)(1) <br />Continuous monitoring system for underground piping <br />102632 (c)(2) <br />Continuous monitoring system for UST <br />_SXR <br />11 <br />HSC 25291(a)(2) <br />Secondary containment for UST is tight <br />12 <br />CCR 2636 (f)(1) <br />Continuous monitoring system for dispenser system <br />137—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 product -tight <br />16 <br />HSC 25292.1 <br />UST system is operated to prevent unauthorized release <br />17 <br />CCR 2650 <br />Recording/reporting unauthorized release <br />18 <br />CCR 2632 (d) <br />Monitoring and response plan <br />19 <br />CCR 2712 (i) <br />Monitoring and response plan is on site <br />20 <br />CCR 2712 (b) <br />Maintenance and monitoring 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 certification <br />24 <br />CCR 2643 (d) <br />Daily monitoring of suction piping that is not continuously <br />monitored <br />PHS 260 (8/04/00) 1 of — <br />