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Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, California95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web.- www.SiQOV,Qcg/ehd <br />Underground Storage Tank Program Inspection Report <br />Facility Phone: Date: <br />Facility Name: <br />'2 <br />CERS ID: <br />Facility Address: <br />J1 1" <br />-title: Phone <br />Inspection Contact: <br />Program! <br />Inspection Type: <br />Service Technician Onsite'. <br />Service Technician Manufacturer's <br />"".11111M K <br />V <br />Consent Given By: <br />8 <br />Exp. Date: FTei�Jgnated Operator: JUN [Up - ud' <br />r <br />� �ie )NNAENTAI <br />U.Te7. <br />v=Violation R= Repeat violation COS- Corrected on site durinE <br />File Review <br />101 <br />HSC 25284 <br />No permit to operate <br />102 <br />HSC 25284(a)(3) <br />No written agreement between tank owner and ta <br />103 <br />HSC 25292.2 <br />Current financial responsibility documents not su <br />104 <br />104 <br />CCR 2711 <br />UST Operating Permit Application for Facility and <br />105 <br />HSC 25286(c) <br />R <br />Current BOE number not submitted <br />106 <br />CCR 2632 <br />Monitoring and response plans not current or ap <br />107 <br />CCR 2632(d)(1)(C) <br />Plot plan/site map not submitted or failed to com <br />108 <br />CCR 2637(f), 2638(e) <br />Failed to notify the EHD 48 hours prior to condu <br />log <br />CCR 2637 <br />Failed to test secondary containment <br />110 <br />CCR 2637(e) <br />Failed to submit secondary containment test rep <br />ill <br />CCR 2638(a) <br />Failed to test monitoring and leak detection equi <br />112 <br />HSC 25284.2 <br />Failed to test spill containers annually <br />113 CCR 2B38(d) <br />Failed to submit m onitoring system certification <br />114 _ CCR 2636(Q <br />Failed to perform 0.1 gph annual line test for pre <br />115 CCR 2715(a) <br />Failed to inform the EHD of a change of designa <br />116 CCR 2715 <br />Designated operator, service tech or installer di <br />117 HSC 25292.6 <br />Failed to conduct ELD testing on a system lova <br />118 _HSC 25292,5 <br />Failed to repair and retest system due to failed <br />119 CCR 2644.1(a)(5) <br />Failed to submit ELD test results within 60 days <br />........... <br />120 CCR 2663 <br />Failed to inspect a lined or repaired steel tank <br />121 CCR 2663 <br />Failed to submit tank lining certification within 3 <br />122 HSC 25299 <br />Documents were falsified or misrepresented <br />123 CCR 2661 <br />Permit to repair UST system not obtained <br />124 CCR 2635(d) <br />Failed to submit UST Certification of Installatio <br />125 COR 2712(f]) <br />Failed to submit a written response within 30 d <br />Received by <br />inspector: <br />(initial): <br />test report within 30 days <br />inspection <br />within <br />0 V <br />uR <br />000S <br />ink FoperaZr to monitor the tank system <br />o V <br />cR <br />o Cos <br />omitted <br />m <br />V <br />OV <br />o R <br />Lj COS <br />Tank information not submitted or current <br />o <br />'o COS <br />uV <br />uR <br />oCOS <br />proved by the EHD EE <br />E4V <br />0 V <br />o R <br />o COS <br />where monitoring is performed <br />❑ V <br />. V <br />0 <br />❑ R <br />n COS <br />pletely show <br />cling testing <br />o V <br />o R <br />13 COS <br />o V <br />o R <br />o COS <br />ort within 30 days <br />o V <br />o R <br />r- COS <br />pment annually <br />o V <br />o R <br />o COS <br />oV <br />oR <br />0 COS <br />test report within 30 days <br />V <br />R <br />o COS <br />ssurized piping without fail safe or shut down <br />V <br />R <br />o C0�s <br />led operator within 30 days <br />o V <br />oR <br />uCOS <br />d not possess current ICC certification <br />n V <br />o�R <br />o COS <br />led within 1000' of a public Well <br />0 V <br />o R <br />o COS <br />ELD test <br />V <br />V <br />o R <br />n COS <br />o V <br />o R <br />n COS <br />10 years of lining and every 5 years after <br />o V <br />o R <br />u COS <br />0 days or to conduct proper tests <br />n V <br />c- R <br />n COS <br />zi V <br />oft <br />o COS <br />V <br />u R <br />o COS <br />n/Modification <br />U V <br />o R <br />o COS <br />ays of receiving an inspection report <br />o V <br />a R <br />o COS <br />Phone: <br />Date: <br />4 fA <br />age V <br />