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SAN JT A UIN COUNTY <br /> r <br /> ONVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton,California 95202-3029 <br /> Telephone:(209)468-3420 Fav(209)468-3433e ®_ .si o�v_or <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> 9 16 <br /> Facility adre UST j <br /> ( Product (/ <br /> Facility Contact: Title: Phone: <br /> -- <br /> Monitor g Pan l: Pi ing system: O4ertd prevention: <br /> Pressurized ❑Suction ❑Gravity �/Mechanical ❑Audible/visual <br /> ection type: Violations: <br /> outine Monitoring Certification ❑Installation ❑Other: ❑M1-RDetect ❑M2-RPrev ❑ -3 Both <br /> VIOLATION(S) FISC=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 <br /> Perra�it too erste <br /> F2 CCR 2637 Seconds containment test erfonmed <br /> 3 CCR 2711 (b)!� c) Current Unified Pro ra m Consolidated Forms on file with EHI� Pacili and tank form) <br /> 4 HSC 25292.2 Certification of financial responsibility and CFO letter <br /> 5 CCR 2632(b Monitd by the local agency. <br /> 6 CCR 2712 i) Monitorin lan is onsite. <br /> ? CCR 2712 b) Maintenance&monitoring records (MI) <br /> 8 CCR 2643(d) Dailmonitoring o€suction pi,J s n1l, 1984) <br /> 9 HSC 25292.1 UST system is o crated to prevent unauthorized release <br /> 10 CCR 2632(c)(2) UST monitorin s stem is resent (Mi) <br /> I I CCR 2630 d) UST system monitorin e ui ment is ro erl located to detect a leak M1 <br /> 72 HSC 25291 b) UST s stem monitorini e ui ment isoperational (M2) <br /> V13 CCR 2636 f) 1 Continuous monitorin s stem for under ound i in �i UI3C is resent Ml) <br /> 14 CCR 2631 (a) PrimTj containment is roduct ti ht <br /> 5 HSC 25291 a 2) Seconds containment for UST is ti ht <br /> 16 CCR 2636(c)(1) All releases in secondary i in flow to a collection sum <br /> 17 HSC 25291 (D Line leak detector s)are installed {Mi) <br /> 18 CCR 2635(b)(1) Spill container (M2) <br /> 19 CCR 2635 b) 2) Overfall revention s stem (M2) <br /> 20 CCR 2636(a) Conventional suction i in shall have continuous monitorin 2°containment <br /> 2I HSC 25291 (e) Water in 2°containment analyzed�i roperly disposed of <br /> 22 CCR 2650 Recordin Ire orcin of unauthorized releases (Mi) <br /> 23 CCR 2715 Desi Hated® erator:(a)Statement from UST owner; (c-e)Monthl inspection;(f)Employee training <br /> 24 CCR 2638 a Annual monitorin certification <br /> 25 CCR 2638(a) Annual line leak detector test (Mi) <br /> 26 HSC 25284.2 Annuals ill containment testin <br /> 27 CCR 2636 4) Annual line tightness test Ml) <br /> 28 CCR 2661 (f) R air for tank/ i in has had ti htness test (M2) <br /> 29 1 CCR 2643 e) Biennial tightness test of ravit i in re-Janus 1, 1984) <br /> 30 CCR 2643(d) Triennial line test for conventional suction piping( re-Janus 1, 1984) (Ml) <br /> 31 HSC 25292.5 Double walls stem located within 1000'of public well-ELD <br /> 32 CCR 2661 Permit to r air UST s stem <br /> 33 HSC 25286(a) Permit to alter monitorin s stem <br /> 34 HSC 25298(b) Permit to temporarily close UST system <br /> 35 1 HSC 25298 c) Permit to close UST s stem <br /> LHC <br /> SC 25299 a)(9) Disablin leak detection devices <br /> SC 25298 a) Ills al abandonment of UST s stem <br /> ther: <br /> E II�ISP CTO : PHONE: UIC <br /> C ® � Septic system: <br /> ❑Serves 220 people/day <br /> R CEIV B TITLE: Receives other than sanitary waste <br /> P�n C/,r Other disposal methods: <br /> / <6 F7 =i wells/French Drains <br /> EHL)23-02-002 REV 05/07 <br />