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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 /> Supervalu 1 1990 N PICCOLI RD, STOCKTON November 19, 2020 <br /> Single-Walled Non-Pressurized Piping <br /> 404 CCR 2643(,),2661(f) Failure to conduct 0.1 gph test on single-walled gravity piping biennially or post repair(pre-1984) ❑V ❑R ❑COS <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 /> 104 CCR 2632(d)(1), 2634(d) Failure to have an approved UST Monitoring Plan. <br /> OBSERVATION: The monitoring plan is not current and/or not approved by the EHD. Name of the second Person <br /> having responsibility has change. <br /> REGULATION GUIDANCE: The monitoring plan must be uploaded to the California Environmental Reporting <br /> System (CERS). <br /> CORRECTIVE ACTION: Immediately log into CERS, make the necessary changes, and submit for review by the <br /> EHD. <br /> This is a minor violation. <br /> 107 HSC 25292.2; CCR 2711(a)(11) Failure to submit and maintain complete and current financial responsibility <br /> documents. <br /> OBSERVATION: The current Financial responsibility documents have not been submitted to the EHD. The most <br /> recent financial responsibility documents in CERS are dated 10/01/2019. <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 /> 109 CCR 2715(a)(1)(B), 2715(a)(3) Failure to submit"Designated Underground Storage Tank Operator Identification <br /> Form"within 30 days. <br /> OBSERVATION: The designated underground storage tank operator identification form was not found in CERS. <br /> REGULATION GUIDANCE: The owner or operator shall submit a "Designated Underground Storage Tank Operator <br /> Identification Form" no later than 30 days after any change in the designated UST operator(s). <br /> CORRECTIVE ACTION: Immediately log into the California Environmental Reporting System (CERS) at <br /> http://cers.calepa.ca.gov and upload the notification identifying all the designated operators for this facility. <br /> This is a repeat violation, Class II. <br /> FA0003826 PR0231820 SCO01 11/19/2020 <br /> EHD 23-01 Rev.9/16/2020 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.sjgov.org/EHD <br />