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S A N .J OA Q U I N AMENDED Environmental Health Department <br />COUNTY— <br />Underground <br />OUNTY <br />Underground Storage Tank Program Inspection Report <br />Facility Name: <br />Facility Address: <br />Date: <br />SAFEWAY FUEL CENTER #2600 <br />1987 W ELEVENTH ST, TRACY <br />June 12, 2018 <br />Complete and submit a copy of the Return to Compliance Certification form to the EHD with a statement <br />documenting the corrective actions that have been or will be taken for each violation, and any supporting <br />paperwork, within 30 days of receiving the complete inspection report. <br />Document reviewed: Monitoring system certification 2015, 2016, and 2017 secondary containment test results <br />2017, employee training, response plan, financial responsibility documents, response plan, monitoring plan and <br />designated operator monthly inspection reports from June 2017- May 2018. <br />Documents provided: Return to compliance certification. <br />Please be aware that as of January 1, 2014, facility operators are required to upload the following UST program <br />documents into the California Environmental Reporting System (CERS): UST Monitoring Site Plan, UST <br />Certification of Financial Responsibility, UST Response Plan, UST Letter from Chief Financial Officer (if <br />applicable), and the Owner Statement of Designated Operator Compliance. The UST Owner/Operator: Written <br />Agreement, if applicable, can be stored at the facility or uploaded into CERS.An inspection checklist was <br />provided to the facility operator at the time of inspection. The EHD will generate and provide a complete report <br />to the facility operator. <br />AFTER THE COMPLIANCE DATE, EHD WILL BILL FOR ALL TIME AND ACTIVITIES ASSOCIATED WITH BRINGING <br />THIS FACILITY BACK INTO COMPLIANCE. <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />Received by: Date: <br />Inspector: <br />Inspector Phone: <br />Printed Name and Title: <br />ZUNA BARKER, EH Specialist <br />(209) 953-7311 <br />FA0013503 PRO517565 SCO01 06/12/201a <br />EHD 23-01 Rev. 10/31/2017 Page 5 of 5 Underground Storage Tank Program OIR <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />