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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, California 95205-6232 Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sicehd.com UNDERGROUND STORAGE TANK UST PROGRAM INSPECTION REPORT Facility Facility Inspection Name: (_,_�f-�a/ �j�5 �r-.. (,JqS(� Phone: Date: ( Z Facility ^�S ,/ L� � ID y Address: �/ v O� Oir Inspection Title: Phone: Contact: InsType: Program: Consent Given For. Consent Inspection ❑ Photos ❑ Sampling Given By: -,,,`� Service Tech Exp. Designated Exp. Onsite: Date: Operator. Date: Service Technician Manufacturefs Training: CCR=California Code of Regulations HSC=Health and Safety Code CFR=Code of Federal Regulations V=Violation R=Repeat COS=Corrected on site during inspection File Review V R COS 101 HSC 25284 No permit to operate(V650) ❑ n 102 HSC 25284(a)(3) No written agreement between tank owner and tank operator to monitor the tank system(V735) ❑ ❑ ❑ 103 HSC 25292.2 Current financial responsibility documents not submitted(V720) ❑ ❑ ❑ 104 CCR 2711 UST operating permit application for facility and tank information not submitted or current(V651) ❑ ❑ ❑ 105 CCR 2632(d)(1) Failed to have an approved UST monitoring plan(V852) ❑ ❑ ❑ 106 CCR 2632(d)(2) Failed to have an approved UST response plan(V853) ❑ ❑ ❑ 107 CCR 2632(d)(1)(C) Plot plan/site map not submitted or tailed to completely show where monitoring is performed(V655) ❑ o ❑ 108 CCR 2637(f), Failed to notify the EHD 48 hours prior to conducting testing(V671) ❑ ❑ ❑ 2638(e) 109 CCR 2637 Failed to test secondary containment(V660) ❑ ❑ ❑ 110 CCR 2637(e) Failed to submit secondary containment test report within 30 days(\/662) ❑ ❑ ❑ 111 CCR 2638(a) Failed to test monitoring and leak detection equipment annually(V659) ❑ ❑ ❑ 112 HSC 25284.2 Failed to test spill containers annually(V661) ❑ ❑ ❑ 113 CCR 2638(d) Failed to submit monitoring system certification test report within 30 days(V823) ❑ ❑ ❑ 114 CCR 2636(f) Failed to perform 0.1 gph annual line test for pressurized piping without fail safe or shut down(V663) ❑ ❑ ❑ 115 CCR 2715(a) Failed to inform the EHD of designated operator identification or change within 30 days(V658) ❑ ❑ ❑ 116 CCR 2715 Designated operator,service tech or installer did not possess current ICC certification(V848) ❑ ❑ ❑ 117 CCR 2663 Failed to inspect a lined or repaired steel tank within 10 years of lining and every 5 years after(V666) ❑ ❑ ❑ 118 CCR 2663 Failed to submit tank lining certification within 30 days or to conduct proper tests(V667) ❑ ❑ ❑ 119 HSC 25299 Documents were falsified or misrepresented(V657) ❑ ❑ ❑ 120 CCR 2635(d) Failed to submit UST Certification of Installation/Modification(V840) ❑ ❑ ❑ 121 CCR 2712(f) Failed to submit a written response within 30 days of receiving an inspection report(V804) ❑ ❑ ❑ 122 CCR 26310) Failure to submit UST system component statement of compatibility for substance stored (V721) ❑ ❑ ❑ On Site Records V R COS 201 CCR 2712(b) Failed to maintain alarm logs and/or records of follow up actions(V725) ❑ ❑ ❑ 202 CCR 2712(b) Failed to maintain cathodic protection test records on site for at least 6 1/2 years(V733) ❑ ❑ ❑ 203 CCR 2712(b) Failed to maintain records of monitoring,repair,lining, and upgrades on site(V732) ❑ ❑ ❑ 204 CCR 2712(i) Current monitoring plan approved by the EHD not found on site(V734) ❑ ❑ ❑ 205 CCR 2712(i) Failure to have an approved UST response plan available onsite(V654) ❑ ❑ ❑ 206 CCR 2712 Failure to comply with UST operating permit conditions(V738) ❑ ❑ ❑ 207 HSC 25294 Failed to record unauthorized release from primary containment(V737) ❑ ❑ ❑ Received Inspector. / Inspector By(initial): 'ZZ S Phone2L-21 1-16K 2 EHD 23-01 REV 07/28/16 Page 1 UST INSPECTION R ORT