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AN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENf <br /> 100 East Main Street, Stockton,California 95202-3029 <br /> Telephone:(209)468-3420 F= (209)468-3433 Web:www.sigov.org/�e d <br /> UNDERGROUNDSTORAGETANK -, <br /> Facili7nam;e: 7 Desi nated Operator: Inspection Date: <br /> Facility add :, ST , <br /> / k <br /> 'Product <br /> ciGty Contact: itle: Phone: - ' <br /> eo <br /> o it g Panel: Piping system: Overfill prevention: <br /> 'r ressurized ❑Suction ❑Gravity ❑Mechanical Audible/visual <br /> Inspection type: Violations: <br /> out* onitorin Certification ❑Installation ❑Other: [I M I-RDetect ❑M2-RPrev ❑M-3 Both <br /> C VIOLATION(S) HSC=California Health s&Safety Code;CCR=California Code of Regulations V R <br /> Code Section V <br /> V=Violation;RV=R eat Vioflation <br /> 1 HSC 25284 Permit too este <br /> 2 CCR 2637 Seconda containment test performed <br /> 3 CCR 2711 b c Current Unified Pro am Consolidated Forms on file with EHD(Facility and tank form) <br /> 4 HSC 25292.2 Certification of financial resnonsibility and CFO letter <br /> 5 CCR 2632 b Monitorin Pro am Monitorin Rcs onse Plan is current and approved by the local agency. <br /> 6 CCR 2712(i) Monitorin len is onsite. <br /> 7 CCR 2712 b) Maintenance&rnonitorin records Ml <br /> 8 1 CCR 2643(d) Dail monitorin of suction i i3re-January, 1, 1984) <br /> 9 1 HSC 25292.1 UST s stem iso erated to revent unauthorized release <br /> 10 CCR 2632 c)(2) UST monitorin s stem is resent (MI) <br /> 11 CCR 2630 d) UST s stem momtonn e ui ment is properly located to detect a leak MI <br /> 12 HSC 25291 ) UST s stem monitorin c ui ment is erational (M2) <br /> 13 CCR 2636 1) Continuous monitorin s stem for under ound i in c&UDC is resent Ml) <br /> 14 CCR 2631 (a) Prima containment is roduct ti ht <br /> 15 HSC 25291 a)2) Seconds containment for US is ti ht <br /> 16 CCR 2636 c)(1) All releases in secondary pipingflow to a collection sum <br /> 17 HSC 25291 Line leak detectors are installed l) <br /> 18 CCR 2635 b) 1) Spill container M2) <br /> 19 CCR 2635 b)2) ®verfill revcntion s stem M2) <br /> 20 CCR 2636(a) Conventional suction i in shall have continuous onitorin +gc 2°containment <br /> 21 HSC 25291 (e) Water in 2°containment analyzed agc ro erly dis osed of <br /> 22 CCR 2650 Recordin r ortin of unauthorized releases l <br /> 23 CCR 2715 Desi nated OLerator(a)Statement from UST owner; (c-e)Monthly inspection;(f)Em to ee training <br /> 24 CCR 2638 aAnnual monitorin certification <br /> 25 CCR 2638(a) Annual line teak detector test ( I) <br /> 26 HSC 25284.2 nual s ill containment testis <br /> 27 CCR 2636 f)4) nual line ti fitness test 1) <br /> 28 CCR 2661 (f) Repair for tank/ i in has had ti htness test (M2) <br /> 29 CCR 2643 e) Biennial ti htness test of avit i in re-Janus 1, 1984) <br /> 30 CCR 2643(d) Triennial line test for conventional suction piping( re-Jana 1, 1984) ( l) <br /> 31 HSC 25292.5 Double welt s stem located within 1000 of ublic well-BLD <br /> 32 CCR 2661 Permit to re air UST system <br /> 33 HSC 25286 a) Permit to alter monitorin s stem <br /> 34 HSC 25298(b) Permit to tem oraril close UST s stem <br /> 35 HSC 25298 c) Permit to close UST s stem. <br /> 36 HSC 25299 a)9) Disablin leak detection devices <br /> 37 HSC 25298 a) (lle al abandonment of UST s stem <br /> Wo <br /> NE: UIC <br /> M, <br /> f2S_pe tic system:C Serves>_20 people/day <br /> T ❑Receives other than sanitary waste <br /> Other disposal methods: <br /> ' =i wells/French Drains <br /> EHD 23-02-002 REV 05/07 <br />