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E: •innL R'.iY`. <br /> ,dvL.�.N�,;;�i`dT:;�HEALTH DE€'i; <br /> Rnfl Pa8t t.Aairt Street Rtnrktnn r.Hiifnrnia g7n9f1.9_.,An9q <br /> i elechone_(209)468-3420 Fax=(209)468-3433 Web wvm.sioq V.Cfg/shdit�ni+iii.htmi <br /> CONTINUATION FORM Page: 3 of 3 <br /> OFFICIAL IM-_P1=rTI0N REPORT <br /> Date: 08/16/11 <br /> r Facility Address: 6131 Pacific Ave, Stockton Program: UST <br /> SUMMARY OF VIOLATIONS <br /> CLASS I,CLASS II,or MINOR-Notice to Comply) <br /> Routine and Monitoring System Certification Underground Storage Tank Inspection <br /> 4. Financial responsibility documents have not been submitted to the EHD. Current financial <br /> responsibility documents are required to be submitted annually. If the UST Cleanup Fund is being used <br /> to satisfy this requirement then a Chief Financial Officer Letter or Certificate of Deposit is required in <br /> conjunction with the UST Cleanup Fund. Complete and submit a legible copy of the financial <br /> responsibility documents by September 16, 2011. <br /> 23c. The designated operator failed to document all the alarms on the May 17, 2011 designated <br /> operator monthly inspection report and failed to check that they were responded to appropriately. The <br /> missing alarms include: Q2 - 91 product - PLLD shutdown and gross line fail - May 10 and May 14, <br /> 2011. A service receipt was available for review but the designated operator did not document the <br /> alarms in the DO report. During the monthly inspection, the designated operator shall review the alarm <br /> history for the previous month, check that each alarm was documented and responded to appropriately, <br /> and attach a copy of the alarm history with documentation taken in response to any alarms to the <br /> monthly report. Ensure that designated operators performing monthly inspections at this facility are <br /> including all of the required information on the reports. <br /> Note <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 September 16, 2011. <br /> ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RATE. <br /> THIS FACT TY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD Inspe Recei d By: Title: <br /> EHD 23-02-0 Rev 07/12/11 CONTINUATION FORM <br />