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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, California 95202-3029 <br /> Telephone: (209)468-3420 Fax:(209)468-3433a .sl oq v.or. /g ehd <br /> UNDERGROUNDT T INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection <br /> Rew Date: <br /> Fa ility ad re UST ," <br /> 'Product Cl 71 <br /> Facility Contact: itle: Phone: <br /> ZiA6A <br /> r ng Panel: Piping system: Overfill prevention: <br /> Pressurized 0 Suction ❑Gravity Mechanical ❑Audible/visual <br /> Ins ection type: Violations: <br /> outine Yi Monitoring Certification ❑Installation ❑Other: 1 ❑M1-RDetect ❑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 Seconda containment test erformedIV 77-10 <br /> 3 CCR 2711 b & c Current Unified Program Consolidated Forms iletwith EHD (Facility and tank form <br /> 4 HSC 25292.2 Certification of isibility and CFO letter <br /> 5 CCR 2632 b Monitorin Pro ramMonitorin &Res onse Plan is current and approved by the local agency. <br /> 6 CCR 2712 i Monitorin Ian is onsite. <br /> 7 CCR 2712 b Maintenance&monitoring records 1 <br /> 8 CCR 2643 d Daily monitoring of suction i in (pre-January, 1, 1984 <br /> 9 HSC 25292.1 UST system is operated to prevent unauthorized release <br /> 10 1 CCR 2632(c)(2) UST monitoring system is present 1 <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 a ui ment iso erational M7 <br /> 13 CCR 2636 1 Continuous monitoring system for underground piping&UDC is present (Mill <br /> 14 CCR 2631 a Primary 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 iping flow to a collection sum <br /> 17 HSC 25291 Line leak detectors are installed 1 <br /> 18 CCR 2635(b)(1) Spill container M2) <br /> 19 CCR 2635(b)(2) Overfill prevention system 102 <br /> 20 CCR 2636(a) Conventional suction piping shall have continuous monitoring&20 containment <br /> 21 HSC 25291 (e) Water in 20 containment analyzed&properly disposed of <br /> 22 CCR 2650 Record in /re ortin g of unauthorized releases M1 <br /> 23 CCR 2715 Designated Operator: a Statement from UST owner; (c-e)Monthly inspection; Employee training <br /> 24 CCR 2638 a Annual monitoring certification jr//z/0 <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 1 <br /> 28 CCR 2661 M Repair for tank/piping has had tightness test 2 <br /> 29 CCR 2643 a Biennial ti htness test of qravity piping (pre-January 1, 1984 <br /> 30 CCR 2643 d Triennial line test for conventional suction pipinq jEe-January1, 1984) M1) <br /> 31 HSG 25292.5 Double walls stem located within 1000' of public well-ELD <br /> 32 1 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 /> 37 1 HSC 25298 a Illegal abandonment of UST system <br /> 38Other: <br /> EHD INSPECT R: 10 PHONE: UIC <br /> `1'[L0 335 Septic system: <br /> ❑Serves>_20 people/day <br /> RECEIV B TITL 11 Receives other than sanitary waste <br /> Other disposal methods: <br /> ❑D wells/French Drains <br /> EHD 23-02-002 REV 8/08 <br />