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0 SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, California 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgoy.org/ehd <br />Facility name: <br />P <br />G" <br />Designated Operator: Insp coon Da <br />CA,45 <br />Facility address: <br />f -r <br />UST # <br />Facility Contact: <br />Title: Phone: <br />N110tori <br />ncl: <br />Piping system: <br />kx�,essurized El Suction El Gravity <br />Overfill prevention: <br />limechanical 11 Audible/visual <br />Ins ection'type: <br />outine k2onitoring <br /># Code Section <br />VIolations: <br />Certification D Installation El Other: El M I - R Detect El M2-RPrev 0 M-3 Both <br />VIOLATION(S) HSC=California Health & Safety Code; CCR=Califomia Code of Regulations V R <br />V=Violation; RV=Repeat Violation V <br />I <br />HSC 25284 <br />Permit too erate <br />2 <br />CCR 2637 <br />Secon IaEZ containment test performed <br />3 <br />CCR 2711 (b) & cj <br />Current Unified Pro ram Consolidated Forms-oirr file with EHD lFacility and tank form) <br />4 <br />HSC 25292.2 <br />Certification of financial res2onsibility and CFO letter <br />5 <br />CCR 2632 (b) <br />Monitoring Program Monitoring & Response Plan) is current and approved by the local aencX. <br />6 <br />CCR 2712 (i) <br />Monitoring plan is onsite. <br />7 <br />8 <br />9 <br />CCR 2712 (b) <br />CCR 2643 (d) <br />- <br />HSC 25292.1 <br />Maintenance & mo <br />Daily monitoring of suction 3 <br />�2��Janua[y, 1, 1984) <br />UST system isoperated to prevent unauthorized release <br />10 <br />1 CCR 2632 (c)(2) <br />UST monitoring system is present (M1) <br />11 <br />CCR 2630 (d) _ <br />UST system monitoring equipment is properly located to detect a leak (M 1) <br />12 <br />13 <br />HSC 25291 b) <br />CCR 2636 (911) <br />UST system monitoring equipment isoperational (M2) <br />Continuous monitoring system for under ground ii in & UDC is 2resent (M1) <br />14 <br />CCR 2631 (a.) <br />Prima a containment is product tiht <br />15 <br />HSC 25291 (a)(2) <br />Secondary containment for UST is ti ht <br />16 <br />CCR 2636 (c)(1) <br />All releases in secondary piping flow to a collection sum2 <br />17 <br />HSC 25291 (f) <br />Line leak detectors ) are installed (M 1) <br />18 <br />19 <br />CCR 2635 (bh 1) <br />CCR 2635 1b)(2) <br />Spill container (M2) <br />Overfill prevention system (M2) <br />20 <br />21 <br />CCR 2636 (a) <br />HSC 25291 (e) <br />Conventional suction <br />Water in 2' containment analyzed & properly disposed of <br />22 <br />23 <br />CCR 2650 <br />CCR 2715 <br />Recording/reporting of unauthorized releases (M 1) <br />Designated Operator: (a) Statement from US 2ection,,,(f) EmploXee trainin� <br />24 <br />CCR 2638 1a) <br />Annual monitorinE certification ------------ <br />25 <br />CCR 2638 (a) <br />Annual line leak detector test (M 1) <br />26 <br />HSC 25284.2 <br />Annual spill containment testin� <br />27 <br />28 <br />CCR 2636 (f)14) <br />CCR 2661 (f) <br />Annual line tightness test (M1) <br />Repair for tank/piping has had tightness test (M2) <br />1 <br />29 <br />CCR 2643 (e) <br />Biennial tightness test ofgraav�it�ire-Janua 1, 1984) <br />30 <br />CCR 2643 (d) <br />Triennial line test for conventional suction piping (pre -January 1, 1984) (M1) <br />31 <br />HSC 25292.5 <br />Double walls stem located within 1000' of public well-ELD <br />32 <br />CCR 2661 <br />Permit to re air UST system <br />33 <br />HSC 25286 1a) <br />Permit to alter monitoring system <br />34 <br />HSC 25298 (b) <br />Permit to temporarily close UST system <br />35 <br />HSC 25298 (c) <br />Pen-nittoclose <br />36 <br />HSC 25299 a)19) <br />Disabling leak detection devices <br />37 <br />HSC 25298 (a) <br />IlleEal abandonment of UST system <br />38 Other: <br />EHD INSPECTORr <br />RECMDI�/, <br />Z'C <br />PHONE4 <br />7- <br />LLL1 <br />TITLE: <br />I <br />IA <br />e UIC, <br />Ss tic system <br />Serves 2!20 people/day <br />Receives other than sanitary waste <br />Other disposal methods <br />- Dry wells/French Drains <br />EHD 23-02-002 REV 05/07 <br />