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I SAN JOAQUIN Environmental Health Department C 00INITY Underground Storage Tank Program Inspection Report Facility Name: Facility Phone: Date: ER Vine Stockton (209) 537-0723 June 24, 2020 Facility Address: I CERS ID: 4733 S HWY 99 , STOCKTON , CA 95206 10399867 Inspection Contact: Title: Phone: Jason Risen Environmental Contact (209) 537-0723 Inspection Type: Program: ROUTINE INSPECTION - Operating Permit 2361 - UST FACILITY Consent For: I consent Olven By: p Inspection 0 Photos O Samples Mike Flores, Technician Service Technician Onsite: Exp, Date: Designated Operator: Exp. Date: Jerry Langrell 07/19/2020 Jerry Langrell 06/26/2021 Service Technician Manufacturer's Training VR, 11/20121 ; VMI , 08/13/21 ; OPW, 08/20/20 CGR = Tide 23 Carfornia Code of Regulations HSC = Health and a elY e CFR = Code 6f FederalegU a Ions V = Violation R = Repeat 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 a V ❑ R ❑ 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 25292.2, 25299.30 Failure to submit and maintain complete and current financial responsibility documents ❑ V ❑ R ❑ COS 104 CCR 2711 UST operating permit application for facility and tank Information not submitted or current ❑ V ❑ R ❑ COS 105 CCR 2632(d)(1), Failed to have an approved UST monitoring plan ❑ V ❑ R a COS 2634(d) 106 CCR 2632(d)(2)5 Failed to have an approved UST response plan n V ❑ R o 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 ❑ R ❑ COS 2711 (a) 108 CCR 26375 2638(e), Failed to notify the EHD 48 hours prior to conducting testing a V DR ❑ COS 2643(g) 109 CCR 2637(a-d), 2712 Failed to test secondary containment, or failed to maintain test records for 36 months ❑ V ❑ R ❑ COS 110 CCR 2637(e), 2637(f) Failed to submit "Secondary Containment Testing Report Form" within 30 days after the test ❑ V DR ❑ COS 111 CCR 26383 2641 Q), Failed to test monitoring and leak detection equipment every 12 months ❑ V ❑ R o COS 2715(f) 112 HSC 25293 Failure to maintain UST records to enable the UPA to determine whether the UST is in compliance o V DR ❑ COS 113 CCR 2638(c)5 2638(d) Failure to submit "Monitoring System Certification Form" within 30 days of completion of the test a V ❑ R ❑ COS 114 CCR 2636(0(3), 2643(c) No 0. 1 gph annual line integrity test for pressurized piping, or within 30 days after repair ❑ V ❑ R ❑ COS (3) 115 CCR 2715(a)(1)(B), "Designated Underground Storage Tank Operator Identification Form" not submitted within 30 days o V ❑ R o COS 2715(a)(3) 116 CCR 2715 Designated operator, service tech or installer did not possess current ICC certification ❑ V DR ❑ COS 117 CCR 2663, 2712(b)(6) Failure to comply with tank lining, recordkeeping, and inspection requirements ❑ V DR ❑ COS 118 CCR 2715(a)(1 )(A), Failure to submit the "Underground Storage Tank Statement of Understanding and Compliance Form" o V DR ❑ COS 2715(a)(2) 119 HSC 25299(a)(8), Documents were falsified or misrepresented _ ❑ V DR ❑ COS 25299(b)(7) 120 CCR 2635(d) Failed to submit UST Certification of InstallalionlModificalion ❑ V ❑ R ❑ COS 121 CCR 2712(f) Failure to implement corrections and submit written response within 30 days of receiving the report ❑ V ❑ R ❑ COS 122 CCR 2631 , 2640.1 , Failure to submit and/or maintain documentation regarding compatibility for UST system components ❑ V DR ❑ COS 2665, 2711 FA0003924 PR0232510 Scoot 06/24/2020 EHD 23-01 Rev. 9/20/2019 Pagel of Underground Storage Tank Program OR 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www. sjcehd.com