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�gUilty <br />SAN JOAQUIN COUNTY <br />N {) ENVIRONMENTAL HEALTH DEPARTMENT <br />6 / 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br />Telephone: (209) 468-3420 Fox: (209) 464-0138 Web: www.sjgov.org/ehd <br />~�UNDERGROUND STORAGE TANK UST) PROGRAMINSPECTION <br />REFORY <br />Facility name: <br />v x <br />V <br />Designated Operat�u m� Inspection Date: <br />�C�� <br />C+ <br />c3 <br />Q,AI-,W ' g„r <br />Permit too erate <br />' 22' <br />Facility address: <br />CCR 2637 <br />UST # <br />" Product <br />tah w <br />3 <br />CCR 2711 (b) & (c) <br />Facility Contact: Title: <br />Phone: <br />4 <br />l 13 t1 tt <br />Certification of financial reTonsibility and CFO letter <br />Monitoring Panel: <br />Piping system: <br />Suction <br />Gfressurized 11[IF-A <br />Gravity <br />Overfill prevention: <br />echanical ❑ Audible/visual <br />Inspection type: <br />CCR 2712 i <br />Violations: <br />C1Koutine Monitoring Certification ❑ Installation <br />❑ Other: <br />❑ M1-RDetect ❑ M2-RPrev ❑ M-3 Both <br /># <br />Code Section <br />VIOLATION(S) HSC=Califomia Health & Safety Code; CCR=Califomia Code of Regulations <br />V=Violation; RV=Re eat Violation <br />v x <br />V <br />1 <br />HSC 25284 <br />Permit too erate <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 reTonsibility and CFO letter <br />5 <br />CCR 2632 (c)(2)(D) <br />Monitoring & res onse plan is current and filed with the local a enc <br />6 <br />CCR 2712 i <br />Monitoring & response plan is onsite <br />7 <br />CCR 2712 b) <br />Maintenance & monitorin records <br />(Mi) <br />8 <br />CCR 2643 d <br />Daily monitoring of suction piping (pre -January, 1, 1984 <br />9 <br />HSC 25292.1 <br />UST system isoperated to 2revent unauthorized release <br />10 <br />CCR 2632 (c)(2) <br />UST monitoring system is present <br />Ml <br />I 1 <br />12 <br />CCR 2630 (d) <br />HSC 25291 b <br />UST system monitorin equipment is properly located to detect a leak <br />UST system monitoring equipment isoperational <br />MI <br />M2 <br />13 <br />CCR 2636 1) <br />Continuous monitoring s stem for underground piping & UDC is present <br />(MI) <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 tight <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 detector(s) are installed <br />(Ml) <br />18 <br />CCR 2635 1 . <br />S ill container <br />M2 <br />19 <br />CCR 2635 (b)(2) <br />Overfill prevention system <br />(M2) <br />20 <br />CCR 2636 (a) <br />Conventional suction pipinE shall have continuous monitoring & 2° containment <br />21 <br />HSC 25291 (e) <br />Water in 2° containment analyzed & pro2erly disposed of <br />22 <br />23 <br />CCR 2650 <br />CCR 2715 <br />Recordin reporting of unauthorized releases <br />Designated Operator: (a) Statement from UST owner; (c -e) Monthly inspection; (f) Employee training1i <br />(MI) <br />24 <br />25 <br />CCR 2638 (a) <br />1 CCR 2638 (a) <br />Annual monitoring certification <br />Annual line leak detector test <br />(MI <br />26 <br />HSC 25284.2 <br />Annuals ill containment testin <br />27 <br />28 <br />CCR 2636 (f)(4) <br />CCR 2661 <br />Annual line tightness test <br />Repair for tank/pipinghas had ti htness test <br />(MI) <br />M2 <br />29 <br />30 <br />CCR 2643 (e) <br />CCR 2643 d <br />Biennial tightness test of gravity piping(re-Janus 1, 1984 <br />Triennial line test for conventional suction piping (pre-January1, 1984 <br />M- <br />31 <br />1 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 teaorarily close UST system <br />35 <br />HSC 25298 (c) <br />Permit to close UST system <br />36 <br />HSC 25299 (a)(9) <br />Disabling leak detection devices <br />37 <br />HSC 25298 a) <br />Illegal abandonment of UST system <br />38 Other: <br />EHD INSPECTOR: PHONE <br />RECEIVED BY: TITLE: <br />EHD 23-02 <br />1/3/07 — <br />UIC <br />Septic system: <br />❑ Serves >_20 people/day <br />❑ Receives other than sanitary waste <br />Other disposal methods: <br />❑ Dry wells/French Drains <br />