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PUBLIC HEALTH SERVICES SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 E. Weber Ave.,Third Floor, Stockton, CA 95202 <br /> (209) 468-3420 <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility Name <br /> Facility Address l <br /> Facilty Contact 1 r 2 Title Phone No. <br /> Program ID# Number of UST(s) <br /> UST#/ProductTj, 9 <br /> Overfill Prevention: Audible and Visual Mechanical <br /> Piping system: Gravity _ Pressure Suction <br /> Monitoring system . Gr t' <br /> Automatic pump shutdown satisfies CCR2636 (g): Yes No <br /> VIOLATION(S) <br /> The above facility is not in compliance with the following section(s)of Health&&Safety Code <br /> (HSC)and/or California Code of Regulations(CCR): <br /> 1 HSC 25284 Permit to operate <br /> 2 HSC 25292.3 Upgrade compliance certificate/sticker <br /> 3 CCR 2711(b)&(c) Current State Form A&B <br /> 4 HSC 25292.2 Certification of financial responsibility and letter from chief financial <br /> officer <br /> 5 CCR 2630(d) Continuous monitoring system for UST system <br /> 6 CCR 2636(c)(1) All releases in secondary piping flow to a collection sump` <br /> 7 CCR 2636(a) Secondary containment for piping is waterproof <br /> 8 CCR 2636(f)(2) Automatic line leak detector(s) <br /> 9 CCR 2636(f)(1) Continuous monitoring system for underground piping <br /> 10 CCR 2632(c)(2) Continuous monitoring system for UST <br /> 11 HSC 25291(a)(2) Secondary containment for UST is tight <br /> 12 CCR 2636(0(1) Continuous monitoring system for dispenser system <br /> 13 CCR 2635 (b)(1) Spill container <br /> 14 CCR 2635 (b)(2) Overfill prevention system <br /> 15 CCR 2631 (a) Primary containment is product-tight <br /> 16 HSC 25292.1 UST system is operated to prevent unauthorized:release <br /> 17 CCR 2650 Recording/reporting unauthorized release <br /> 18 CCR 2632(d) Monitoring and response plan <br /> 19 CCR 2712(i) Monitoring and response plan is on site <br /> 20 ,,-CCR 2712(b) Maintenance and monitoring records <br /> 21 CCR 2636(0(4) Annual line tightness test <br /> 22 CCR 2630(d) Annual line leak detector test <br /> 23 CCR 2630(d) Annual monitoring certification <br /> 24 CCR 2643 (d) Daily monitoring of suction piping that is not continuously <br /> monitored <br /> 1 of <br /> PHS 260(8/04,100) <br />