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TRANSMISSION VERIFICATION REPORT <br /> TIME : 09/26/2018 15:46 <br /> NAME : SJC EHD UNIT 3 <br /> FAX : 2094683433 <br /> SER. # : BROM7F534354 <br /> DATE DIME 09/26 15: 44 <br /> FAX N0./NAME 93341873 <br /> DURATION 00: 02:27 <br /> PAGE(S) 06 <br /> RESULT OK <br /> MODE STANDARD <br /> ECM <br /> S NJ O A Q I N Environmental Health Department <br /> c'.. f .,..6 <br /> Fsclflty Name; Facility Phone: Da"ll'i Nn= <br /> te: <br /> FLAG CITY CHEVRON (209) <br /> Facilitcliffy Address <br /> 334-1873 September 26,2018 <br /> : <br /> 6421 CAPITOL AVE, LODI,CA 95242 CERS ID: <br /> Inspection Contact- a.- Phone: 10180605 <br /> Azad Amid Owner <br /> inspection Type: Program: (925)464-3635 <br /> ROUTINE INSPECTION-Operating Permit 2361 -UST FACILITY <br /> Consent For,, Consent Given By: <br /> 0Ins ection Z Photos ®Samples Klumars Khajevandi, Cashier <br /> Service Technician Onsite: Exp.Date: Designated Operator: Exp.Date• <br /> Zane Nimmo 06/02/2019 Alex Jibbari 10/0-312018 <br /> Sdrvice Technician Manufacturer's Trainfrtg: <br /> Veeder Root,09128110; VMI,01/08119;Tank Tester, 03/31/19 <br /> CCR=TiU6 23 Cafto Code of Regulations HSG=Health and Safety Code CFR=Code of Federal Regulations <br /> V=VoWon R-Repeat Aoiatim Cost Corrected on site during Inspection <br /> 101 HSC 25284 Failure to obtain a valid permit to operate from the END Including but not limited to unpaid fees o V OR o COS <br /> 102 HSC P6264(e)(3)(A)/(B) No written agreement between tank owner and tanK operator to monitor the tank System a V E3 R o COS <br /> 103 HSC 25297.2.,25299.30 Current financial responsibility documents riot submlttad ■V r R a COS <br /> 104 CCR 2711 UST operating permit application for facility and tank l0fibrmation not submitted or current a V o R c COS <br /> 105 CCR 2632(d)(1), Failed to have an approved UST monitoring pian 2634(d) o V ❑R o COS <br /> 106 CCR 2632(d)(2), Failed to have an approved UST response plan <br /> 2834(e v V a R v COS <br /> 107 CCR 2632(d)(1)(C) Plot Alen/site map not submittAd or failed t4 completely Show where monitoring is performed p V ❑R q COLS <br /> 108 CCR 2637M.2638(e) Failed to notify the EHD 48 hours prior to conducting testing o V a R 0 COS <br /> 109 CCR 2637 Failed 10 test secondary containment <br /> DV ❑R o COS <br /> 110 CCR 2637(e) Failed to submit seoondery r:ont2lnment test report within 30 days ❑V OR ❑COS <br /> 111 CCR 2838(a) Failed t0 test Monitoring and leak detection equipment annually OV ❑R D COS <br /> 112 HSC 25284.2 Failed to test spill containrirs annually 0 V 0 R U COS <br />