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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)468-3433 Web:www.sjgov.org�ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility name: Designated Operator: Inspection Date: <br /> Designated Ox -R <br /> 30dLVk0& Ice_ <br /> Facility a dr s: A UST# <br /> t <br /> Pr® &.]� <br /> FContact: Title: Phone: <br /> It <br /> =Nk 3T (1166 91 d1l <br /> Monitoring Panel: Pi ing system: Overfill prevention: <br /> --d El Suction 0 Gravity 4mechanical [I Audible/visual <br /> Inspection type: Violations: <br /> IdRoutine El Monitoring Certification El Installation El Other: j 14MI-RDetect 0 M2-RPrev 0 M-3 Both <br /> # Code Section VIOLATION(S) HSC=California Health&Safety Code;CCR=Califomia Code of Regulations V <br /> R <br /> V=Violation; RV=Re2cat Violation V <br /> I HSC 25284 Permit too2erate <br /> • 2 CCR 2637 Secondary containment test performed <br /> 3 CCR 2711 (b)&(c) Current Unified Program 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 Proram(Monitoring&Response Plan)is current and approved by the local agency. <br /> 6 CCR 2712(i) Monitorin lan is onsite. <br /> 7 CCR 2712(b) Maintenance&monitoring records _5 <br /> 8-- CCR 2643(d) Daily monitorinof suction piping(pre-Januaa, 1, 1984) <br /> 9 HSC 25292.1 UST system iso2erated to revent unauthorized release <br /> 10 CCR 2632 c)(2) UST moniton*nsystem is 2resent (M 1) <br /> • I I CCR 2630(d) UST system monitoring equipment is properly located to detect a leak jm 1) <br /> 12 HSC 25291 b) UST system monitorinE equi2ment i122Lrational (M2) <br /> 13 CCR 2636 l) Continuous monitorinE system for underground piping&UDC is 2resent M1) <br /> 14 CCR 2631 (a) Prima ry 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 second2a 2iping flow to a collection sump <br /> 17 HSC 25291 (D Line leak detectors are installed <br /> • 18 CCR 2635(b) I) Spill container (M2) <br /> 19 CCR 2635 b)(2) Overfill prevention system (M2) <br /> 20 CCR 2636(a) Conventional t <br /> 21 HSC 25291 (e) Water in 2'containment analyzed&properly disposed of <br /> 22 CCR 2650 Recording/reporting of unauthorized releases (M1) <br /> 23 CCR 2715 Designated Operator:(a)Statement from UST owner; (c-e)Monthly inspection;(f)Employee trainin� <br /> A 24 CCR 2638 a) Annual monitoring certification <br /> 25 CCR 2638(a) Annual line leak detector test (M1) <br /> • 26 HSC 25284.2 Annual spill containment testing <br /> —27 CCR 2636(f)(4) Annual line tihtness test (M 1) <br /> 28 CCR 2661 (f) Re air for tank/piping has had tightness test (M2) <br /> 29 CCR 2643(e) Biennial tightness test of gravity gi2inE(pre-January 1, 1984) <br /> 30 CCR 2643(d) Triennial line test for conventional suction piping(pre-January 1, 1984) (M1) <br /> 31 HSC 25292.5 Double walls stem located within 1000"of public well-ELD <br /> 32 CCR 2661 Permit to repair UST system <br /> 33 HSC 25286 aPermit to alter monitorinsystem <br /> 34 1 HSC 25298(b) Permit to temporarilv close UST system <br /> 35 HSC 25298(c) Permit to close UST system <br /> 36 HSC 25299(a)(9) DisablinE leak detection devices <br /> 37 HSC 25298(a) Illegal abandonment of UST system <br /> 38 Other: <br /> EHD INSPECTO::,fM PHONE: UIC <br /> Septic system: <br /> Serves�-�,20 people/day <br /> RECEIVED BV-. TITLE: Receives other than sanitary waste <br /> Other disposal methods: <br /> IDry Drains&—ad-" -ry 422 <br /> EHD 23-02-002 REV 05/07 <br />