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r E �i 0 4 2020 F 'BA1RECEIVED 76 � I IV Environmental Health Department T Y / \ ENVIRONMECNTALaU HtjALTH v�U o pERMIT / SERVICES Underground Storage Tank Program Inspection Report Facility Name: Facility Phone: Date: CHEVRON USA 9201761 (209) 825-0714 January 02, 2020 Facility Address: CERS ID: 1103 S MAIN ST, MANTECA, CA 95337 10181653 Inspection Contact: Title: Phone: Luisa Verduzco [ Manager (209) 825-0174 Inspection Type: Program: ROUTINE INSPECTION - Operating Permit 2361 - UST FACILITY Consent For: Consent Given By: 2 Inspection N Photos 9 Samples Luisa Verduzco , Manager Service Technician Onsite: Exp. Date: Designated Operator: Exp. Date: Brent Bowen 06/23/2021 Service Technician Manufacturer's Training : VR , 04/21 /21 , VMI , 07/19/21 CCR = Title 23 California Code of Regulations HSC = Health and Safety Code CFR = Code of Federal Regulations 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 o V o R o COS 2711 (d) 102 HSC 25284(a)(3) (A)/(B) No written agreement between tank owner and tank operator to monitor the tank system c V o R e COS 103 HSC 25292,2, 25299. 30 Failure to submit and maintain complete and current financial responsibility documents o V o R o COS 104 CCR 2711 UST operating permit application for facility and tank information not submitted or current c V o R o COS 105 CCR 2632(d)(1 ) , Failed to have an approved UST monitoring plan c V o R o COS 2634(d) 106 CCR 2632(d)(2) , Failed to have an approved UST response plan ❑ V o R o COS 2634(e) 107 CCR 2632(d), 2641 (h), Plot plantshe map not submitted or failed to completely show where monitoring is performed o V o R o COS 2711 (a) 108 CCR 2637, 2638(e), Failed to notify the EHD 48 hours prior to conducting testing o V n R o COS 2643(8) 109 CCR 2637(a-d), 2712 Failed to test secondary containment, or failed to maintain test records for 36 months o V e R ❑ COS 110 CCR 2637(e), 2637(!) Failed to submit "Secondary Containment Testing Report Form" within 30 days after the test o V e R D COS 111 CCR 2638, 2641 Q), Failed to test monitoring and leak detection equipment every 12 months o V o 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 o R o COS 113 CCR 2638(c), 2638(d) Failure to submit "Monitoring System Certification Form" within 30 days of completion of the test o V D R D COS 114 CCR 2636(f)(3), 2643(c) No 0 . 1 gph annual line integrity test for pres7uhzed piping , or within 30 days after repair o V o R o COS (3) 115 CCR 2715(a)( 1 )(8) , "Designated Underground Storage Tank Operator Identification Form" not submitted within 30 days e V o R o COS 2715(a)(3) 116 CCR 2715 Designated operator, service tech or installer did not possess current ICC certification o V o R o COS 117 CCR 2663, 2712(b)(6) Failure to comply with tank lining, recordkeeping, and inspection requirements o V o R ❑ COS 118 CCR 2715(a) ( 1 )(A) , Failure to submit the "Underground Storage Tank Statement of Understanding and Compliance Form" D V ❑ R ❑ COS 2715(a)(2) 119 HSC 25299(a)(8), Documents were falsified or misrepresented ❑ V D R o COS 25299(b)(7) 120 CCR 2635 (d) Failed to submit UST Certification of Installation/Modification o V e R o COS 121 CCR 2712(f) Failure to implement corrections and submit written response within 30 days of receiving the report o V ❑ R D COS 122 CCR 2631 , 2640. 11 Failure to submit and/or maintain documentation regarding compatibility for UST system components o V ❑ R ❑ COS 2665, 2711 FA0004521 PR0232587 SCO01 0110212020 EHD 23-01 Rev 9202019 Pagel of 5 Underground Storage Tank Program OIR 1868 E Hazelton Avenue ( Stockton , California 95205 1 T 209 468 - 3420 F 209 464-0138 1 www sjcehd . com