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SAN JOAQUIN COUNTY -
<br /> ENVIRONMENTAL HEALTH DEPARTMENT
<br /> 304 East Weber Avenue,3`d Floor,Stockton,CA 95202-2708 ='
<br /> Telephone:(209)468-3420 Fax.(209)468-3433 Web:www.sj&6v.org/ehd
<br /> UNDERGROUND STORAGE TANK(UST2 PROGRAM INSPECTION REPORT
<br /> tility name: Designated Oper'tor: Inspection Date:
<br /> �t� i(t� �Q S.Q VYl ��� I Cf�`S� ���� ,. � �('�t0�✓ 1�� 1� � 21 fr
<br /> i Facilityaddress: 1 n UST#
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<br /> Y ` Product 'Olf c
<br /> ctTit e: Phoneynel: Piping system: Overfill prevention:
<br /> 50 Pressurized. ❑Suction ❑Gravi ;. : Mech nical El Audible/visual
<br /> e: Violations; -
<br /> Routine Monitoring Certification ❑Installation 0 Other: MI-RDetect ❑M2-RPrev ❑M-3 Both
<br /> Code Section
<br /> �IOLATION(S)HSC`California Health'&SaatetyCode;CCR=California'Code of Regulations V R
<br /> V=Violation;RV=R t Violation V
<br /> I HSC 2528.4, Permit to o
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<br /> 3 CCR 2711:(b)'&(c) Current Unified Pro`` Consolidated.Fortns on file with EHD(Facilityand tank form
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<br /> 5 CCR 2632"c 2 onitorin &�res onse plan iscurrent'and filed with the local=a enc
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<br /> 7 CCR'2712 Maintenance&monitorin -records 1
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<br /> 9 HSC_ 25292:1` USTs Mein as o rated to revent unauthorized release
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<br /> - H .3. _..:.b..• _-.a3-, .ec.a,..sx, bs"..` vk�'. •-3:3. ?Y 1�
<br /> CGit 630 ii" UST's , ern.11, or n " ui trt`is ro " fl located to detet:t;a leak 1
<br /> CCR 2636 1 Continuous nonitonn s eni:for und°' ound i in &UDC is went 1
<br /> 15 ` HSC 25291''a 2 - Second containment for UST is ti ht
<br /> �� - .. ... Y .: � - .�• a z"» . a d "aL�x b �.� �"'a c �, _ bye
<br /> 17? HS
<br /> C25291 Line leak detectors ate installed 1VI1
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<br /> 19 CCR 2635,(1))(1),%' 0ierfi11 revention s 'tem 2
<br /> 3M L
<br /> 2,1 HSC'25291 lei Wates in 20"containriren'analyzed& o afs sed of
<br /> K`110
<br /> � s3 3 c.
<br /> 23m\ CCR;2715 Desi' aced rator:`a'Stateement,from UST owner; c-e Monthl in ' ctro, to trainin
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<br /> 25" "CCR-208'a Ann'ual-line leak detector test 1
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<br /> 27 CCR 2636 4 AnnuaC luie.ti`htness test I
<br /> 3
<br /> 29' CCR 2543 e ;; Biennial Mess test of. vi in re-J 'u 1,1.94 .
<br /> 'g r q __ '• v k' fir, c d L 33 .m
<br /> 31 HSC 25292.5 Double wall:s stem located within 1000'of ublie well-ELD
<br /> 33 HSC'25285': Pertnit to:altet tnonitorin s em
<br /> 35 HSC 25298,c Permit to close UST s'"stem- '
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<br /> 37 HSC 25298 a Ille ai abandonment of UST s stem
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<br /> E INSPECTOR: PHONE: _ UIC
<br /> 6r lt.
<br /> Septic'system:
<br /> r1 Q Serves 220 people/day
<br /> E E Y TITLE: ❑Receives other than sanitary waste
<br /> t� Other disposal methods:
<br /> ❑ wells/Freneb Drains
<br /> FHiI 214024X)2
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