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A J OA U I Environmental Health Department <br /> COUNTY <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Address: Date: <br /> SHOP N GO 3 4511 PACIFIC AVE, STOCKTON February 25, 2020 <br /> Other Violations <br /> 2010 1 See below Unlisted General violation ❑V ❑R ❑COS <br /> SUMMARY OF VIOLATIONS <br /> (CLASS I,CLASS II,or MINOR-Notice to Comply) <br /> Item# Remarks <br /> 103 HSC 25292.2, 25299.30 Failure to submit and maintain complete and current financial responsibility documents. <br /> OBSERVATION: Financial responsibility documents have not been submitted to the EHD. The most recent <br /> financial responsibility documents in CERS are dated 5/3/2018. <br /> REGULATION GUIDANCE: Current financial responsibility documents are required to be submitted annually. <br /> CORRECTIVE ACTION: Immediately log into the California Environmental Reporting System (CERS) at <br /> http://cers.calepa.ca.gov/, and upload the required documents. <br /> This is a minor violation. <br /> 110 CCR 2637(e), 2637(f) Failed to submit"Secondary Containment Testing Report Form"within 30 days after the test. <br /> OBSERVATION: Secondary containment testing was performed on 07/11/2018 test results not submitted to EHD. <br /> REGULATION GUIDANCE: A test report has not been submitted to the EHD or the California Environmental <br /> Reporting System (CERS). A copy of the 'Secondary Containment Testing Report Form' must be submitted within <br /> 30 days of the test. <br /> CORRECTIVE ACTION: Immediately provide this report to the EHD. <br /> This is a minor violation. <br /> 113 CCR 2638(c), 2638(d) Failure to submit"Monitoring System Certification Form"within 30 days of completion of the <br /> test. <br /> OBSERVATION: A monitoring system certification, leak detector testing, and spill container testing were performed <br /> on 02/05/2019. Atest report has not been submitted to the EHD or the California Environmental Reporting System <br /> (CERS). <br /> REGULATION GUIDANCE: A copy of the test report must be submitted within 30 days of the test. <br /> CORRECTIVE ACTION: Immediately provide this report to the EHD. <br /> This is a minor violation. <br /> FA0002480 PR0231216 SCO01 02/25/2020 <br /> EHD 23-01 Rev.9/20/2019 Page 4 of 7 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 />