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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, California 95202-3029 Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sugov.or4/ehd/unitiii.html CONTINUATION FORM Page: 3 of 3 OFFICIAL INSPECTION REPORT Date: 06/02/11 Facility Address: Safeway #2600 1987 West 11th Street, Tracy Program: UST SUMMARY OF VIOLATIONS CLASS I,CLASS II,or MINOR-Notice to Comply) UST Inspection: Routine and Annual Monitoring System Certification testing 4. Financial responsibility documents have not been submitted to the EHD. Last Certification of Financial Responsibility document signed on 08/2009. Insurer Indian Harbor Insurance Company policy for UST coverage period for 07/2007 - 07/2010. Current financial responsibility documents are required to be submitted annually. Complete and submit a copy of the financial responsibility. 5. The Monitoring Plan on site are not current and not approved by the EHD. An incorrect sensor model for the annular space was listed. An 91/diesel annular sensor was changed under permit on 06/11/07 from a VR 420 to a VR 460 but the Monitoring Plan was not updated to include this change. In addition, all Monitoring System Certification test results from 2008 to present has yet to reflect the change in sensor model. The Monitoring Plan must be current and approved by the EHD. Complete and submit a copy of the Monitoring Plan for approval by the EHD. An approved copy will be returned for your records. 10 & 12. The 87 annular sensor was found not to be resting at the bottom of the annular space bottom when tested and, therefore, the tank is not monitored. The depth of the annular was measured to be 188 inches and was found to be ten inches too short. The interstitial space shall be monitored with a monitoring system connected to an audible and visual alarm system. The VR 420 sensor was replaced with a VR 460 sensor serial number#741249 and retested during the inspection. Obtain a permit from the EHD for this work within one business day. If a permit is not obtained within one business day, a "Failure to Obtain a Permit" penalty will apply. 23d. The Designated Operator (DO) failed to verify that all employees have received annual refresher training every 12 months. Maria L. and William K. were both last trained on 03/10/10. Maria recently had her annual refresher training on 04/19/11. William has yet to receive training as of today. Ensure the DO trains employees every twelve months. Submit to SJC EHD within 30 days (07/04/11): 1. one copy of the completed "Return to Compliance Certification" form 2. a written corrective action statement for the above violations 3. requested/ supporting documentation Notes: - Next tri-annual secondary containment testing due 12/2011. ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RATE($122). THIS FACILITY IS SUBJECT TO REINSPECTION AT Ayy TIME OT EHD'S CURRENT HOURLY RATE. EHD In a or. Received By- Title: EHD 23-02-003 Rev 08/10/10 CONTINUATION FORM