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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 <br />Facilty Contact <br />Program ID# <br />UST# / Product <br />Overfill Prevention: Audible and Visual <br />Piping system: Gravit <br />Title Phone No.X3 <br />Number o T(s) <br />Mechanical <br />Pressure ;/ Suction <br />Monitoring systems 7 s—d <br />Automatic pump shutdown satisfies CCR2636 (g): Yes No <br />VIOLATIONS) <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 <br />2 HSC 25292.3 <br />3 CCR 2711(b) & (c) <br />4 HSC 25292.2 <br />5 <br />CCR 2630 (d) <br />6 <br />CCR 2636 (c)(1) <br />7 <br />CCR 2636 (a) <br />8 <br />CCR 2636 (f)(2) <br />9—W --CCR 2636 (f)(1) <br />10 <br />CCR 2632 (c)(2) <br />11 <br />HSC 25291(a)(2) <br />12 <br />CCR 2636 (f)(1) <br />13 <br />CCR 2635 (b)(1) <br />14 <br />CCR 2635 (b)(2) <br />15 <br />CCR 2631 (a) <br />16 <br />HSC 25292.1 <br />17 <br />CCR 2650 <br />18 <br />CCR 2632 (d) <br />19 <br />CCR 2712 (i) <br />20 <br />CCR 2712 (b) <br />21 <br />X CCR 2636 (f)(4) <br />22:XCCR 2630 (d) <br />23 <br />CCR 2630 (d) <br />24 <br />CCR 2643 (d) <br />Permit to operate <br />Upgrade compliance certificate/sticker <br />Current State Form A & B <br />Certification of financial responsibility and letter from chief financial <br />officer <br />Continuous monitoring system for UST system <br />All releases in secondary piping flow to a collection sump <br />Secondary containment for piping is waterproof <br />Automatic line leak detector(s) <br />Continuous monitoring system for underground piping <br />Continuous monitoring system for UST <br />Secondary containment for UST is tight <br />Continuous monitoring system for dispenser system <br />Spill container <br />Overfill prevention system <br />Primary containment is product -tight <br />UST system is operated to prevent unauthorized release <br />Recording/reporting unauthorized release <br />Monitoring and response plan <br />Monitoring and response plan is on site <br />Maintenance and monitoring records <br />Annual line tightness test <br />Annual line leak detector test <br />Annual monitoring certification <br />Daily monitoring of suction piping that is not continuously <br />monitored <br />PHS 260 (8/04/00) 1 of <br />