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Y Page 1 of 4 $an 4oaquin County SEP 106 Environmental Health Department 1866 East Hazelton Avenue, Stockton, Caftmia06205-Ei232 ENViRONMENTAL To/ep4o0e; (209 .466-64�0 Fax; (209) 08-3.433 Web:. mMliggy.orgrehd HEALTH DEPARTMEN angst Fac s B ass Kl GGA (9181564-3300 Se tember 03 2015 1104nit8yAddress: VRIES RD ODI CA 95240 Cuts ID.; 10181479 nd ori Contact tIDE Jonathan Pakele Title! Verizon Assoclate OM 916 X139-6042 nsp6ction pe: ROUTINE INSPECT O - 012erafina Permit ogrsm; 2361 . UST FACILITY Conllerrt Far: II$' �� , on ® Photo# Consent tihred Y► 131 SannDles I Jonathan Pa eleVerizon Associate 3ervh* Technician bnsitz Ruben R201.0 EW Da4t;. 03/13/2017, Designated Operator; David Smith Stip NO: f 0610712016 ea Teohnibian Manufacturees Tralning. Pnaurneraator, 7116116 W: 4 101 ea HSO 26284 eq V = VbW n R z rteplia1 *101lon Cob = Corrneted on este dudn9 insPQdftcm No permit to operate a V a R q e% 102 HSC 20284(a)(3) No written agn3eritent between tank owner and tank operator to rnbnitor the tank system la V u R a Co$ 103 HOC 25292.2 Ourrent financial responsibility riocurnents not submitted a V ❑ R d COS 10+3 COR 2791 IAST Operating Permit Application (or Faoill)y and Tank information net submitted or current a V a R 000's 106 HSC 25286(c) Current HOE number not submitted a V u R a COS 106 CCR 2692 Monkoting and response plaits not current or approved by the EHD a V a R t 008 107 OCR 2632(d)(i)(C) Piot plantaite map not submitted or failed to comptetoly sh4W Where monitoring is performed a V a R C1008 108 CCR 2637(1}, 2038(e) Failed to notify the EHD 48 hours poor to conducting testing a V ❑ R a COS 109 CCR 2637 Failed to teat secondary containmarit a V o R a Ct3S 110 CCR 2637(e) Failed to submit secondary containment test report within 20 days D V a R ri COS 111 CCR 2636(a) Failed to test monitoring and leek detection equipmept annually a :o R a:CO3. 112 HSC 26284.2 Failed to toot spill containers annually ❑ V ❑ R a COS 113 CCR 2638(d) Failed to submit monitoring system certification test report within 30 days a V a R a COS 114 CCR 26360) Failed to perform 0.1 gph annual Ane test for pressurized piping without fall safe or shut down a V o R a COS 115 CCR 2715(a) Failed to Inform the EHD of a change of designated operator within 30 days D V a R MOM 1 iB CCR 2715 Designated operator; service tech or Installer did not possess current ICC certification u V ❑ R a COS 117 HSC 25292.5 Failed to conduct ELD testing on a system located within 1000' of a public well o V a R a COS i 1 B HSC 25292.6 Failed to repair and retest system due to failed EID test ❑ V a R a COS 1i9 CCR 2644.1(a)(5) Fatted to submit ELD fast results within 60 days o V o R a COS 120 CCR 2683 Failed to inspect a lined or repaired steel tank within 10 years of lining and every 6 years after o V ❑ R a COS 121 CCR 2663 Failed to submit tank lining certification within 30 days or to conduct proper tests q V a R ❑ COS 122 HSC 25299 Documents were falsified or misrepresented o V u R a COS 123 CCR 2661 Permit to repair UST system not obtained a V o R a COS 124 CCR 2635(d) Faded to submit UST Certification of InstallationXModiftation a V u R a COS 125 CCR 2712M Failed to submit a written response within 30 days of receiving an Inspection report u V ❑ R ❑ COS Race red byinspector* (Initial): ARTS VELOSO, Senior REHS Phone. (209) 468-3453 139tel 09103/2015 Page 1 of 4