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r I SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, California 95202-3029 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjdov.org/ehd UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT Facility name: Designated Operator: bDate: Inspection Facility a dres -rt, UST # " - Product Facility onta : Title: Phone: 4' MQ On Panel jiping system: ressurized❑ Suction ❑ Gravity Overfill prevention: ❑Mechanical ❑Audible/visual Inspection type: f ❑ Routine Monitoring Certification ❑ Installation ❑ Other: Violations: ❑ M1-RDetect ❑ M2-RPrev ❑ M-3 Both # Code Section VIOLATION(S) HSC=California Health & Safety Code; CCR=California Code of Regulations V R V=Violation; RV=Re eat Violation V 1 HSC 25284 Permit tooperate 2 CCR 2637 Secondary containment test performed 3 CCR 2711 b & c Current Unified Program Consolidated Forms on file with EHD(Facility and tank form 4 HSC 25292.2 Certification of financial responsibility and CFO letter 5 CCR 2632 b Monitoring Program(Monitoring & Response Plan is current and approved by the local agency. 6 CCR 2712 i Monitoring Ian is onsite. 7 CCR 2712 b Maintenance & monitoring records yr? -C ?�Or C, _n/ (M1) 8 CCR 2643 d Daily monitoring of suction piping (pre-Janua, 1, 1984 9 HSC 25292.1 UST system isoperated to prevent unauthorized release 10 1 CCR 2632 (c)(2) UST monitoring system is present (M1) 11 CCR 2630 d UST system monitoring equipment is properly located to detect a leak (M1) 12 HSC 25291 b UST system monitoring equipment is operational (M1) 13 CCR 2636 1 Continuous monitorings stem for underground piping & UDC is present (M1) 14 CCR 2631 a Primary containment is product tight 15 HSC 25291 (a)(2) Secondary containment for UST is tight 16 CCR 2636 (c)(1) All releases in secondary piping flow to a collection sum 17 HSC 25291 f Line leak detector(s) are installed (M1 18. . 26351 Spil.;cont 'ner (M2) 19 ? 35 , III n (M2) 20 CCR 2636 (a) Conventi nal suction piping shall havecontinuous monitoring& 20 containment 21 HSC 25291 (e) Water in 20 containment analyzed & properly disposed of 22 CCR 2650 Recording/reporting of unauthorized releases (M1) 23 CCR 2715 Designated Operator: a Statement from UST owner; (c -e) Monthly inspection; Employee training 24 CCR 2638 a Annual monitoring certification 25 CCR 2638 a Annual line leak detector test (M1) 26 HSC 25284.2 Anrival spill containment testing 27 CCR 2636 4 Annual line tightness test (M1 28 CCR 2661 Repair for tank/piping has had tightness test (M2) 29 CCR 2643 a Biennial tightness test of gravity piping(pre-January 1, 1984 30 CCR 2643 d Triennial line test for conventional suction piping (pre -January 1, 1984) (M1) 31 HSC 25292.5 Double walls stem located within 1000' of public well-ELD n/ 32 CCR 2661 Permit to repair UST system 33 1 HSC 25286 a Permit to alter monitoring system 34 HSC 25298 b Permit to temporarily close UST system 35 HSC 25298 c Permit to close UST system 36 HSC 25299 (a 9 2 Disabling leak detection devices 37 HSC 25298 a Illegal abandonment of UST system 38 O her: EHD INS CTOR: � PHONE � „' a. f YY�r UIC Septic system: ❑ Serves >_20 people/day ❑ Receives other than sanitary waste Other disposal methods: ❑ Dry wells/French Drains RECEIVED R.aG:. �` TITLE: EHD 23-02-002 REV 8/08 UST INSPECTION FINAL