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Environmental Health Department Facility Name: WOODBRIDGE AM PM* Facility Address: 18806 N LOWER SACRAMENTO RD, WOODBRIDGE, CA 95258 Facility Phone: (209) 339-8238 Program: 2361 - UST FACILITY Inspection Type: ROUTINE INSPECTION - Operating Permit Date: April 23, 2018 CERS ID: 10181237 Inspection Contact: Sandesh Bola Consent For: Consent Given By: Sandesh Bola, Manager Title: Manager Phone: (209) 339-8238 T Inspection T Photos £ Samples Underground Storage Tank Program Inspection Report Service Technician Manufacturer's Training: VR, 07/06/18; VMI, 11/06/19; TT, 05/31/20 Service Technician Onsite: Felix Ramirez Exp. Date: 11/22/2018 Designated Operator: Felix Ramirez Exp. Date: 02/27/2020 R = Repeat violation COS = Corrected on site during inspectionV = Violation CCR = California Code of Regulations HSC = Health and Safety Code CFR = Code of Federal Regulations File Review 101 □ V □ R □ COSFailure to obtain a valid permit to operate from the EHD including but not limited to unpaid feesHSC 25284 102 □ V □ R □ COSNo written agreement between tank owner and tank operator to monitor the tank systemHSC 25284(a)(3)(A)/(B) 103 □ V □ R □ COSCurrent financial responsibility documents not submittedHSC 25292.2, 25299.30 104 □ V □ R □ COSUST operating permit application for facility and tank information not submitted or currentCCR 2711 105 □ V □ R □ COSFailed to have an approved UST monitoring planCCR 2632(d)(1), 2634(d) 106 □ V □ R □ COSFailed to have an approved UST response planCCR 2632(d)(2), 2634(e) 107 □ V □ R □ COSPlot plan/site map not submitted or failed to completely show where monitoring is performedCCR 2632(d)(1)(C) 108 □ V □ R □ COSFailed to notify the EHD 48 hours prior to conducting testingCCR 2637(f), 2638(e) 109 □ V □ R □ COSFailed to test secondary containmentCCR 2637 110 □ V □ R □ COSFailed to submit secondary containment test report within 30 daysCCR 2637(e) 111 □ V □ R □ COSFailed to test monitoring and leak detection equipment annuallyCCR 2638(a) 112 □ V □ R □ COSFailed to test spill containers annuallyHSC 25284.2 113 □ V □ R □ COSFailed to submit monitoring system certification test report within 30 daysCCR 2638(d) 114 □ V □ R □ COSFailed to perform 0.1 gph annual line test for pressurized piping without fail safe or shut downCCR 2636(f) 115 □ V □ R □ COSFailed to submit to EHD notification of designated operator identification or change w/in 30 daysCCR 2715(a) 116 □ V □ R □ COSDesignated operator, service tech or installer did not possess current ICC certificationCCR 2715 117 □ V □ R □ COSFailed to inspect a lined or repaired steel tank within 10 years of lining and every 5 years afterCCR 2663(h) 118 □ V □ R □ COSFailed to submit tank lining certification within 30 days or to conduct proper testsCCR 2663 119 □ V □ R □ COSDocuments were falsified or misrepresentedHSC 25299(a)(8), 25299(b)(7) 120 □ V □ R □ COSFailed to submit UST Certification of Installation/ModificationCCR 2635(d) 121 □ V □ R □ COSFailed to submit a written response within 30 days of receiving an inspection reportCCR 2712(f) 122 □ V □ R □ COSFailure to submit and maintain UST system component statement of compatibility for substance storedCCR 2631(j) On Site Records 201 □ V □ R □ COSFailure to maintain monitoring, maintenance, and follow up action recordsCCR 2712(b) Page 1 of 4 FA0003607 PR0232388 SC001 04/23/2018 EHD 23-01 Rev. 10/31/2017 Underground Storage Tank Program OIR 1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com