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RECEIVED JAN 15 LULD i C t W/o l �C SAN J i Environmental Health Department coo ' Underground Storage Tangy Program Inspection Report Facility Name: Facility Phone: Date: CHEVRON STATION #210997 " (209) 599-0149 January 15, 2020 Facility Address: CERS ID: 1442 Colony Dr, RIPON , CA 95336 10184539 Inspection Contact: Title: Phone: Karina Gordillo Store Manager (209) 599 0149 Inspection Type Program: ROUTINE INSPECTION - Operating Permit 12361 - UST FACILITY Consent For. I Consent Given By : ® Inspection N Photos ❑ Samples I Karina Gordillo , Store Manager Service Technician Onsite: Exp. Date: Designated Operator: Exp. Date: Jarrod Cooke 04/03/2021 Eric Aranda 03/21 /2020 Service Technician Manufacturer's Training : VMI , 04/ 11 /21 ; OPW, 01 / 17/20 ; VR , 04/ 17/20 CCR = Title 23 California Code of Raguleltons HSC = Health and Safety Code CFR = Code of Federal Regulations V = Violation R = Repeal violation COS = Corrected on site during inspection File Review 101 HSC 25284; CCR Failed to obtain a permit to operate from the EHD including but not limited to unpaid permit fees o V o R o COS 2711 (d) 102 HSC 25284 (a)(3) (A)/(B) No written agreement between tank owner and tank operator to monitor the tank system o V ❑ R o COS 103 HSC 25292,21 25299,30 Failure to submit and maintain complete and current financial responsibility documents o V a R o COS 104 CCR 2711 UST operating permit application for facility and tank information not submitted or current ❑ V o R o COS 105 CCR 2632(d)(1 )t Failed to have an approved UST monitoring plan a V ❑ R o COS 2634(d) 106 CCR 2632(d)(2) , Failed to have an approved UST response plan o V o R a COS 2634(e) 107 CCR 2632(d), 2641 (h), Plot plan/site map not submitted or failed to completely show where monitoring is performed ❑ V o R ❑ COS 2711 (a) 108 CCR 2637, 2638(e) , Failed to notify the EHD 48 hours prior to conducting testing o v OR a COS 2643(g) 109 CCR 2637(aA) , 2712 Failed to test secondary containment, or failed to maintain test records for 36 months o V OR ❑ COS 110 CCR 2637(e), 2637(1) Failed to submit "Secondary Containment Testing Report Form" within 30 days after the test o V o R ❑ COS 111 CCR 2638, 26410), Failed to test monitoring and leak detection equipment every 12 months o V ❑ R o COS 2715 (0 112 HSC 25293 Failure to maintain UST records to enable the UPA to determine whether the UST is in compliance a V o R o COS 113 CCR 2638(c), 2638(d) Failure to submit "Monitoring System Certification Form" within 30 days of completion of the test o V a R o COS 114 CCR 2636(f)(3), 2643(c) No 0. 1 gph annual line integrity test for pressurized piping, or within 30 days after repair o V a R o COS (3) 115 CCR 2715(a)(1 )(B) , "Designated Underground Storage Tank Operator Identification Form" not submitted within 30 days o V a R o COS 2715(a)(3) 116 CCR 2715 Designated operator, service tech or installer did not possess current ICC certification o V o R o COS 117 CCR 26638 2712(b)(6) Failure to comply with tank lining, recordkeeping , and inspection requirements o V a R o COS 118 CCR 2715(a)(1 )(A), Failure to submit the "Underground Storage Tank Statement of Understanding and Compliance Form" o V o R ❑ COS 2715(a)(2) 119 HSC 25299(a)(8), Documents were falsified or misrepresented o V ❑ R o COS 25299(b)(7) 120 CCR 2635(d) Failed to submit UST Certification of Installation/Modification o V o R ❑ COS 121 CCR 2712(f) Failure to implement corrections and submit written response within 30 days of receiving the report a V ❑ R a COS FA0013918 PRO518458 SC001 01 /15/2020 i EHD 23-01 Rev, 91202019Page 1 of 4 Underground Storage Tank Program OIR 1868 E. Hazelton Avenue ( Stockton , California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www. sjcehd . com i