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SAN -JO QUI N <br />--COU NTY <br />�r <br />=x . Greatness gtows here - <br />Environmental Health Department <br />Underground Storage Tank Program Inspection Report <br />Facility Name: Facility Phone: <br />7 -ELEVEN INC #20632 (209) 952-3543 <br />Date: <br />February 05, 2020 <br />Facility Address: <br />4627 DA VINCI DR, STOCKTON, CA 95207 <br />CERS ID: <br />10165883 <br />Inspection Contact: <br />Gurpreet Matharu <br />Title: <br />Manager <br />Phone: <br />(209) 952-3543 <br />Inspection Type: <br />ROUTINE INSPECTION - Operating Permit <br />Program: <br />12361 - UST FACILITY <br />Consent For: <br />0 Inspection 0 Photos ❑ Sample <br />I Consent Given By: <br />I David Hara, Cashier <br />Service Technician Onsite: Exp. Date: <br />Jesus Saldivar 06/13/2021 <br />Designated Operator: Exp. Date: <br />Kevin Dutra 07/29/2021 <br />Service Technician Manufacturer's Training <br />VMI, 11/12/21; SB, 06/09/22; VR, 04/28/20 <br />CCR = Title 23 California Code of Regulations HSC = Health and Safety Code CFR = Code of Federal Regulations <br />V = Violation R = Repeat violation COS = Corrected on site during inspection <br />File Review <br />101 <br />HSC 25284; CCR <br />2711(d) <br />Failed to obtain a permit to operate from the EHD including but not limited to unpaid permit fees <br />❑ V ❑ R ❑ COS <br />102 <br />HSC 25284(a)(3)(A)/(B) <br />No written agreement between tank owner and tank operator to monitor the tank system <br />❑ V ❑ R ❑ COS <br />103 <br />HSC 25292.2, 25299.30 <br />Failure to submit and maintain complete and current financial responsibility documents <br />❑ V ❑ R ❑ COS <br />104 <br />CCR 2711 <br />UST operating permit application for facility and tank information not submitted or current <br />❑ V ❑ R ❑ COS <br />105 <br />CCR 2632(d)(1), <br />2634(d) <br />Failed to have an approved UST monitoring plan <br />❑ V ❑ R ❑ COS <br />106 <br />CCR 2632(d)(2), <br />2634(e) <br />Failed to have an approved UST response plan <br />❑ V ❑ R ❑ COS <br />107 <br />CCR 2632(d), 2641(h), <br />2711(a) <br />Plot plan/site map not submitted or failed to completely show where monitoring is performed <br />❑ V ❑ R ❑ COS <br />108 <br />CCR 2637, 2638(e), <br />2643(g) <br />Failed to notify the EHD 48 hours prior to conducting testing <br />❑ V ❑ R ❑ COS <br />109 <br />CCR 2637(a -d), 2712 <br />Failed to test secondary containment, or failed to maintain test records for 36 months <br />❑ V ❑ R ❑ COS <br />110 <br />CCR 2637(e), 2637(f) <br />I Failed to submit "Secondary Containment Testing Report Form" within 30 days after the test <br />■ V ❑ R ❑ COS <br />111 <br />CCR 2638, 2641 Q), <br />2715(f) <br />Failed to test monitoring and leak detection equipment every 12 months <br />❑ V ❑ R ❑ COS <br />112 <br />HSC 25293 <br />Failure to maintain UST records to enable the UPA to determine whether the UST is in compliance <br />❑ V ❑ R ❑ COS <br />113 <br />CCR 2638(c), 2638(d) <br />Failure to submit "Monitoring System Certification Form" within 30 days of completion of the test <br />❑ V ❑ R ❑ COS <br />114 <br />CCR 2636(f)(3), 2643(c) <br />(3) <br />No 0.1 gph annual line integrity test for pressurized piping, or within 30 days after repair <br />❑ V ❑ R ❑ COS <br />115 <br />CCR 2715(a)(1)(B), <br />2715(a)(3) <br />"Designated Underground Storage Tank Operator Identification Form" not submitted within 30 days <br />❑ V ❑ R ❑ COS <br />116 <br />CCR 2715 <br />Designated operator, service tech or installer did not possess current ICC certification <br />❑ V ❑ R ❑ COS <br />117 <br />CCR 2663, 2712(b)(6) <br />Failure to comply with tank lining, recordkeeping, and inspection requirements <br />❑ V ❑ R ❑ COS <br />118 <br />CCR 2715(a)(1)(A), <br />2715(a)(2) <br />Failure to submit the "Underground Storage Tank Statement of Understanding and Compliance Form" <br />❑ V ❑ R ❑ COS <br />119 <br />HSC 25299(a)(8), <br />25299(b)(7) <br />Documents were falsified or misrepresented <br />❑ V ❑ R ❑ COS <br />120 <br />1 CCR 2635(d) <br />Failed to submit UST Certification of Installation/Modification <br />❑ V ❑ R ❑ COS <br />121 <br />CCR 2712(f) <br />Failure to implement corrections and submit written response within 30 days of receiving the report <br />❑ V ❑ R ❑ COS <br />FA0002541 PR0231074 SCO01 02/05/2020 <br />EHD 23-01 Rev. 9/20/2019 Page 1 of 4 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 />