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San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd <br />Facility Name: I Facility Address: I Date: <br />mber 03. 2015 <br />Item # I Remarks <br />CCR 2715 Designated operator did not inspect all required items and/or the inspection reports not completed. <br />The designated operator failed to check and note the correct test dates for the monitoring system certification testing <br />on the 4-2-15 designated operator monthly inspection report and for the spill container testing on the 5-26-15 <br />designated operator monthly inspection report. The monitoring system certification testing date was listed as 9-11-4 <br />and the spill container test date was listed as 9-1-14. These test dates should have been listed as 9-11-14. During the <br />monthly inspection, the designated operator shall check that all required testing and maintenance for the UST system <br />have been completed and document the dates they were done. Ensure that designated operators performing monthly <br />inspections at this facility are including all of the required information on the reports. <br />This is a repeat violation, Class 11. <br />Overall Inspection Comments: <br />On site to conduct a routine inspection and witness the annual monitoring system certification testing. <br />Complete and submit a copy of the Return to Compliance Certification form to the EHD with a statement <br />documenting the corrective actions that have been or will be taken for each violation, and any supporting <br />paperwork, by 10-3-15. <br />Please be aware that as of January 1, 2014, facility operators are required to upload the following UST program <br />documents into the California Environmental Reporting System (CERS): UST Monitoring Site Plan, UST <br />Certification of Financial Responsibility, UST Response Plan, UST Letter from Chief Financial Officer (if <br />applicable), and the Owner Statement of Designated Operator Compliance. The UST Owner/Operator: Written <br />Agreement, if applicable, can be stored at the facility or uploaded into CERS. <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />Received By Received By (printed name and title): Date: <br />(signature): Jonathan Pakele, Verizon Associate , <br />nspector�IA (y10Ua1QJ Inspectorector Phone: <br />0/ Inspector printed name and title): <br />(,signature): ARISVELOSO, Senior REHSWM <br />1(209)468-3153 <br />