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Environmeltal Health Department <br /> SAN,*JOAQUIN <br /> -COUNTY--- <br /> rt'"?f?jE i q r n v <br /> Underground Storage Tank ProgramInspection Repor <br /> Facility Name: Facility Phone: Date: <br /> ESCALON MINI MART (209) 838-1546 January 11, 2016 <br /> Facility Address: CERS ID: <br /> 1097 YOSEMITE AVE, ESCALON, CA 95320 10180561 <br /> Inspection Contact: Title: Phone: <br /> Charidy SSchreiber Manager <br /> Inspection Type: Program: <br /> ROUTINE INSPECTION -Operating Permit 12361 - LIST FACILITY <br /> Consent For: Consent Given By: <br /> Z Inseection 21 Photos M Samples I Charidy SSchreiber, Manager <br /> GCR=Ualitornia Code or Regulations H5G=Health and batety Code GFR=Code of Federal Regulations <br /> V=Violation R=Repeat violation COS=Corrected on site during inspection <br /> 0 CCR 2644.1(a)(5) Failed to submit ELD test results within 60 days ❑V ❑R ❑COS <br /> 'File Review <br /> 101 HSC 25284 Failure to obtain a valid permit to operate from the EHD including but not limited to unpaid fees ci V Li R Ei COS <br /> 102 HSC 25284(a)(3)(A)/(B) No written agreement between tank owner and tank operator to monitor the tank system Ei V Li R Ei COS <br /> 103 HSC 25292.2,25299.30 Current financial responsibility documents not submitted n V w R Ei COS <br /> 104 CCR 2711 UST operating permit application for facility and tank information not submitted or current Ei V o R ii COS <br /> 105 HSC 25286(c) Current BOE number not submitted Ei V Ei R o COS <br /> 107 CCR 2632(d)(1)(C) Plot plan/site map not submitted or failed to completely show where monitoring is performed m V Ei R o COS <br /> 108 CCR 2637(f),2638(e) Failed to notify the EHD 48 hours prior to conducting testing Ei V Ei R ci COS <br /> 109 CCR 2637 Failed to test secondary containment ii V o R ii COS <br /> 110 CCR 2637(e) Failed to submit secondary containment test report within 30 days o V o R Fi COS <br /> 111 CCR 2638(a) Failed to test monitoring and leak detection equipment annually o V o R Ei COS <br /> 112 HSC 25284.2 Failed to test spill containers annually ii V ri R Ei COS <br /> 113 CCR 2638(d) Failed to submit monitoring system certification test report within 30 days Li V o R o COS <br /> 114 CCR 2636(f) Failed to perform 0.1 gph annual line test for pressurized piping without fail safe or shut down o V o R o COS <br /> 115 CCR 2715(a) Failed to submit to EHD notification of designated operator identification or change Win 30 days m V Lj R o COS <br /> 116 CCR 2715 Designated operator,service tech or installer did not possess current ICC certification ii V c R o COS <br /> 117 CCR 2663(h) Failed to inspect a lined or repaired steel tank within 10 years of lining and every 5 years after Li V Ei R o COS <br /> 118 CCR 2663 Failed to submit tank lining certification within 30 days or to conduct proper tests Ei V Ei R Li COS <br /> 119 HSC 25299(a)(8), Documents were falsified or misrepresented Li V o R ii COS <br /> 25299(b)(7) <br /> 120 CCR 2635(d) Failed to submit UST Certification of Installation/Modification Ei V Li R n COS <br /> 121 CCR 2712(f) Failed to submit a written response within 30 days of receiving an inspection report Li V ii R o COS <br /> 123 CCR 2661 Permit to repair UST system not obtained ci V Li R o COS <br /> 126 HSC 25404(e)(4) Failed to report program data electronically ❑V o R ci COS <br /> On Sfte,Redoros , <br /> 201 CCR 2712(b) Failure to maintain monitoring, maintenance,and follow up action records mV iiR o COS <br /> 202 CCR R 2712(b) Failed to maintain cathodic protection test records on site for at least 6 1/2 years EiV oR Li COS <br /> FA0000279 PR0231497 SCO01 01/11/2016 <br /> EHD 23-01 Rev.10/31/2017 Page I of 6 Underground Storage Tank Program OIR <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />