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SAN JOAQUIN COUNTYNo,IF C F, W E C <br /> J <br /> VENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, California 95202-3029L 0 8 2009' <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sigov.org/ehd <br /> UNDERGROUND STORAGE TANK UST PROGRAM INSPECT 'i <br /> ItEALTH <br /> rg <br /> Facility name: Designated Opera_jjj or: ection <br /> clI),Ci" Z e llt,#pj Dat <br /> Woe7 <br /> Facility address: UST <br /> o Product l�l <br /> Facility Contact: Title: Phone: - <br /> -� r fA A1..i Ntie 1r1✓1. l on l� i`� 5� <br /> Monitoring Panel: Piping system: Overfill prevention: <br /> G ❑Pressurized ❑Suction ❑GravityMechanical ❑Audible/visual <br /> nspection type: Violations: <br /> ❑Routine d nnonitoring Certification ❑Installation ❑Other: ❑M1-RDetect ❑M2-RPrev ❑M-3 Both <br /> # Code Section VIOLATION(S) HSC=California Health&Safety Code; CCR=California Code of Regulations V R <br /> V=Violation; RV=Re eat Violation V <br /> 1 HSC 25284 Permit tooperate <br /> 2 CCR 2637 Secondarycontainment test performed <br /> 3 CCR 2711 b & c Current Unified Program Consolidated Forms on file with EHD (Facilityand tank form <br /> 4 HSC 25292.2 Certification of financial responsibility and CFO letter <br /> 5 CCR 2632 b MonitoringProgram (Monitoring& Response Plan is current and approved b the local agency. <br /> 6 CCR 2712 i MonitoringIan is onsite. <br /> 7 CCR 2712 b Maintenance&monitoring records M1) <br /> 8QC.R 2643 d Daily monitoringin of suction i (pre-January, 1, 1984 <br /> T HSC 25292.1 UST system isoperated to prevent unauthorized release <br /> is 10 CCR 2632(c)(2) UST monitorings stem is present (M1) <br /> 11 CCR 2630 d UST system monitoring equipment is properly located to detect a leak (M1) <br /> 12 HSC 25291 b UST system monitoring equipment is operational (M1) <br /> 13 CCR 2636(f)(1) Continuous monitorings stem for underground piping&UDC is present (M1) <br /> 14 CCR 2631 a Primary containment is product tight <br /> 15 HSC 25291 (a)(2) Seconda containment for UST is tight <br /> 16 CCR 2636(c)(1) All releases in secondary pipingflow to a collection sum <br /> 17 HSC 25291 l LIhe'leak detector(s)are installed (M1) <br /> 18 CCR 2635(b)(1) Spill container (M2) <br /> 19 CCR 2635(b)(2) Overfill prevention system (M2) <br /> 20 CCR 2636(a) Conventional suction pi in shall have continuous monitoring'&20 containment <br /> 21 HSC 25291 (e) Water in 21 containment analyzed&properly disposed of <br /> 22 CCR 2650 Recording/reporting Recording/reportingof unauthorized releases M4y <br /> 23 CCR 2715 Designated Operator: a Statement from UST owner; (c-e)Monthly inspection; Employee training <br /> 24 CCR 2638 a Annual monitoringcertification <br /> 25 CCR 2638 a Annual line leak detector test M1) <br /> `. 26 HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636 4 Annual line tightness test (M1 <br /> 28 rCCR 2661 Repair for tank/piping has had tightness test (M2) <br /> 29 CCR 2643 a Biennial tightness test of gravity piping (pre-January 1, 1984 <br /> 30 CCR 2643 d Triennial line test for conventional suction piping(pre-January 1, 1984) (M1 <br /> i 31 HSC 25292.5 Double walls stem located within 1 000'of public well-ELD <br /> 32 CCR 2661 Permit to repair UST system <br /> 33 HSC 25286 a Permit to alter monitoring system <br /> 34 HSC 25298 b Permit to temporarily close UST system <br /> 35 HSC 25298 c Permit to close UST system <br /> 36 HSC 25299 Disabling leak detection devices <br /> a 9 2 - <br /> 137 HSC 25298 a Ille al abandonment of UST system <br /> 38 Other: , <br /> EHD INSPECTOR: , PHONE: UIC <br /> Se13tic system: <br /> ❑Serves>_20 people/day <br /> RECEIVE BY: TITLE: ❑Receives other than sanitary waste <br /> Other disposal methods: <br /> ✓�S ❑D wells/French Drains <br /> EHD 23-02-002 REV 8/08 i <br /> - V <br />