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SAN JOAQUIN COUNTY <br /> 1;NVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3`a F1oot;Stockton-,,CA 95202-2708 <br /> Telephone:(209)468-3420 F jx:(209)468-3433 jf�eb:www.sigov.or <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> Grein 61 ' 4 04li�J <br /> Facility address:: UST# <br /> Product ��� <br /> Facility Contact: Title: Phone: <br /> � (- ` 6 --5 Z-1 V <br /> Monitoring Panel: Pipi stem: _Over�T prevention: <br /> ressurized ❑Suction 11Gravit Mechanical ❑Audible/visual <br /> Ins ion type: Violations: <br /> Routine ElMonitoring Certification [IInstallation ElOther: ❑MI-RDetect 11 M2-RPrev ❑M-3 Both <br /> VIOLATION(S) HSC=California Health&Safety Code;CCR=California Code of Regulations V R <br /> # Code Section V <br /> V=Violation;RV=Re eat Violation <br /> 1 HSC 25284 Permit tooperate <br /> 2" CCR 2637 Secondary containment test performed D-tk «r <br /> 3 CCR 2711 b & c Current Unified Program Consolidated Forms on fileAvith EHD(Facility and tank form <br /> HSC 25292. Certification of financial responsibility and CFO letter <br /> 5-' 2632 c 2 D Monitoring&response plan is current and filed with the local agency <br /> W) CCR 2712 i Monitoring&response plan is onsite <br /> 7 CCR 2712 b Maintenance&monitoring records Ml <br /> 8 CCR 2643 d Daily monitoring of suction piping(pre-January, 1 1984 <br /> 9 HSC 25292.1 UST system isoperated to prevent unauthorized release <br /> 10 CCR 2632 c 2 > UST monitoring system is present MI <br /> 11 CCR 2630 d UST system monitoring equipment is properly located to detect a leak M1 <br /> 12 HSC 25291 UST system monitoring equipment iso rational M2 <br /> 13 CCR 2636 1 Continuous monitoring system for underground piping&UDC is present M1 <br /> 14 CCR 2631 a Prinwy containment is product tight <br /> 15 HSC 25291 (a)(2) Secondary containment for UST is tight <br /> 16 CCR 2636(c)(1) All releases in secondary i in flow to a collection sum <br /> 17 HSC 25291 Line leak detectors are installed M1 <br /> 18 CCR 2635 )(1) Spill container M2 <br /> 19 CCR 2635(b)(2) Overfill pTevention system M2 <br /> 20 '' CCR 2636(a) Conventional suction piping shall have continuous monitoring&2'containment <br /> 21 HSC 25291 (e) Water in 2°containment analyzed&properly disposed of <br /> 22 CCR 2650 Recordingtreporting of unauthorized releases Ml <br /> 23 CCR 2715 Designated Operator:(a)Statement from UST owner; (cInlonthiy ins-p-e-a-i-on-7ff Em to ee trainin <br /> 24 CCR 2638-a Annual monitoring certification <br /> 25 CCR 2638(a) Annual line leak detector test (Mi) <br /> 26 HSC 25284.2 Annuals ill containment testing <br /> 27 CCR 2636 4 Annual line tightness test Ml <br /> 28 CCR 2661 Repair for tTn-k7piping 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( re-Jana 1, 1984) (Mi) <br /> 31 HSC 25292.5 Double walls stem located within 1000'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 ) Permit to temporarily close UST system <br /> 35 HSC 25298 c Permit to close UST system <br /> 36 HSC 25299(a)(9) Disabling leak detection devices <br /> 37 HSC 25298 a) Illegal abandonment of UST system <br /> 38 Other: <br /> EHD INSPECTOR: PHONE- UIC <br /> 3 septicsystem: <br /> l� �]Serves>_20 people/day <br /> RECEIVE Y• TITLE: Receives other than sanitary waste <br /> tt/I t!�'' Other disposal methods: <br /> Dry wells/French Drains <br /> EHD 23-02-002 <br />