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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.swgov.orci/ehd/unitiii.html <br /> CONTINUATION FORM Page: 4 of <br /> OFFICIAL INSPECTION REPORT Date: <br /> Facility Address: >049 Ernbarcauc,i- Program: UST <br /> SUMMARY OF VIOLATIONS <br /> CLASS 1,CLASS II,or MINOR-Notice to Comply) <br /> 23c. The designated operator failed to check and note the correct test date for the triennial secondary <br /> containment testing on the 2/2011 designated operator monthly inspection report. The date used on the <br /> report is 8/08. The correct date is 4-30-09. During the monthly inspection: the designated operator shall <br /> check that all required testing and maintenance for the UST system have been completed and document <br /> the dates they were done. Ensure that designated operators performing monthly inspections at this <br /> facility are including all of the required information on the reports. <br /> Notes <br /> 1. Complete and submit a copy of the Return to Compliance Certification form with a statement of how <br /> each violation was corrected; including supporting documentation., by April 23; 2011. <br /> 2. Discussed possible dispenser replacements with Mike Spence. The inspector told Mike that a repair <br /> ;permit is required from the Environmental Health Department for this work. <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 ANYTIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD I ctor: Receiv By: Title: <br /> EHD 2 2-003 Rev 08/10 10 CONTINUATION FORM <br />