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46 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.sjgov.orehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> FFFacility name: Designated Operator: Inspection Date: <br /> P A4 fl A <br /> 'IKA 16-A-ts <br /> Facilit/ ad es <br /> &I I- $ <br /> lf I U_S_T_# <br /> Pro7Tduct I - - <br /> Im I'% ' , ' I I <br /> F cility Contact: Title: Phone: 7� <br /> f <br /> Tj4jAjed MML. <br /> ®MoniMonitoring Panel: P' mg system: Overfill prevention: <br /> toring <br /> &C.Z IRPressurized El Suction a El Gravity Alechanical El Audible/visual <br /> Inspection type: Violations: <br /> 11 Routine Aonitoring Certification D Installation 11 Other: El M I_RDetect XM2-RPrev El M-3 Both <br /> # Code Section VIOLATION(S) HSC=Califomia Health&Safety Code;CCR=Califomia Code of Regulations V R <br /> V=Violation;RV=RMeat Violation V <br /> I HSC 25284 Permit too2erate <br /> • 2 CCR 2637 Secondary containment test Eerformed <br /> 3 CCR 2711 (b)& c) Current Unified Pro ram Consolidated Forms on file with EHD Facility and tank form) <br /> 4 HSC 25292.2 Certification of financial responsibility and CFO letter <br /> • 5 CCR 2632 b) Monitoring Pro ram Monitoring&Response Plan)is current and approved by the local agency. <br /> • 6 CCR 2712(i) MonitorinE 2Ian is onsite. <br /> 7 CCR 2712 b) Maintenance&monitoring records (Mi) <br /> 8 CCR 2643(d) Daily monitoring of suction piping(pre-Janusa, 1, 1984) <br /> 9 HSC 25292.1 UST system isoperated to prevent unauthorized release <br /> 10 CCR 2632(c)(2) UST monitorinsystem is present (M 1) <br /> • 11 CCR 2630 d) UST system monitoring Equi2ment is 2roperly located to detect a leak (M 1) <br /> 12 HSC 25291 (b) UST s stem monitoring equi2ment isoperational (M2) <br /> • 13 CCR 2636(f)(1) Continuous monitorina system for underground piping&UDC is present (M 1) <br /> 14 CCR 2631 (a) Prima containment is product ti ht <br /> 15 HSC 25291 a)(2) Secondary containment for UST is tiht <br /> 16 CCR 2636(c)(1) All releases in seconds!j 2i2ing flow to a collection sump <br /> 17 HSC 25291 (f) Line leak detecto!ls)are installed Ml) <br /> e 18 CCR 2635(b)(1) Spill container (M2) Z7: <br /> 19 CCR 2635(b)(2) Overfill prevention system (M2) <br /> 20 CCR 2636(a) Conventional suction piping shall have continuous monitoring&2'containment <br /> 21 HSC 25291 (e) Water in 2'containment analyzed&2ro2erly dis2osed of <br /> 22 CCR 2650 Recording/reporting of unauthorized releases (M 1) <br /> f 23 CCR 2715 Desi gnated22erator:(a)Statement from UST owner; (c-e)Monthly inspection,(f)Employee t2jajaa_ <br /> 110 24 CCR 2638(a) Annual monitoring certification <br /> 0 25 CCR 2638(a) Annual line leak detector test (M 1) <br /> 0 26 HSC 25284.2 Annual s2ill containment testing <br /> 27 CCR 2636 4) Annual line tightness test (M1) <br /> 28 1 CCR 2661 (f) Repair for tank/piping has had tightness test (M2) <br /> 29 CCR 2643(e) Biennial tightness test of gravity piping(pre-January 1, 1984� <br /> 30 CCR 2643(d) Triennial line test for conventional suction 2i2ina( re-Janus a 1, 1984) (M1) <br /> 31 HSC 25292.5 Double wall system located within 1000'of public well-ELD <br /> 32 CCR 2661 Permit to repair UST system <br /> 33 HSC 25286(a) Permit to alter monitoring system <br /> 34 1 HSC 25298(b) Permit to temporarily close UST system <br /> 35 HSC 25298(c) Permit to close UST system <br /> 36 HSC 25299(a)(9) Disabling leak detection devices <br /> 37 HSC 25298(a) Illegal.abandonment of UST system <br /> 38 Other: <br /> EHD INSPECTOR: eN PHONE: uIr <br /> Septic system: <br /> Serves�!20 people/day <br /> RECEIVED BY: TITLE: Receives other than sanitary waste <br /> Other disposal methods: <br /> Dry wells/French-Drains <br /> y <br /> EHD 23-02-002 REV 05/07 <br />