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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.siclov.orci/ehd/unitiii.html <br /> CONTINUATION FORM Page: 3 of 3 <br /> OFFICIAL INSPECTION REPORT Date: 06/02/11 <br /> Facility Address: Safeway#2600 1987 West 11th Street, Tracy Program: UST <br /> SUMMARY OF VIOLATIONS <br /> CLASS I,CLASS II,or MINOR-Notice to Comply) <br /> UST Inspection: Routine and Annual Monitoring System Certification testing <br /> Inspection and written report performed on 06/02/11 <br /> Amended written report on 06/03/11-changed violation from #10 & 12 to #11 <br /> 4. Financial responsibility documents have not been submitted to the EHD. Last Certification of Financial <br /> Responsibility document signed on 08/2009. Insurer Indian Harbor Insurance Company policy for UST <br /> coverage period for 07/2007 - 07/2010. Current financial responsibility documents are required to be <br /> submitted annually. Complete and submit a copy of the financial responsibility. <br /> 5. The Monitoring Plan on site are not current and not approved by the EHD. An incorrect sensor model <br /> for the annular space was listed. An 91/diesel annular sensor was changed under permit on 06/11/07 <br /> from a VR 420 to a VR 460 but the Monitoring Plan was not updated to include this change. In addition, <br /> all Monitoring System Certification test results from 2008 to present has yet to reflect the change in <br /> sensor model. The Monitoring Plan must be current and approved by the EHD. Complete and submit a <br /> copy of the Monitoring Plan for approval by the EHD. An approved copy will be returned for your <br /> records. <br /> 11. The 87 annular sensor was found not to be resting at the bottom of the annular space bottom when <br /> tested and, therefore, the monitoring equipment is not maintained to be able to detect a leak at the <br /> earliest possible opportunity. The depth of the annular was measured to be 188 inches and was found to <br /> be ten inches too short. The interstitial space shall be monitored with a monitoring system connected to <br /> an audible and visual alarm system. The VR 420 sensor was replaced with a VR 460 sensor serial <br /> number#741249 and retested during the inspection. Obtain a permit from the EHD for this work within <br /> one business day. If a permit is not obtained within one business day, a "Failure to Obtain a Permit" <br /> penalty will apply. <br /> ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RATE($122). <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD Ins ect r: Received By: Title: <br /> rjA_4R k_'( �_4 � I,a <br /> EHD 23-02-003 Rev 08/10/10 CONTINUATION FORM <br />