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Ol Environmental Health Department <br /> SANJ`" t= i'__ —COUNTY— <br /> Greatness <br /> C U N T ISI <br /> Greatness grows Frere, <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Phone: Date: <br /> MY MINI MART (209)941-2246 June 06,2019 <br /> Facility Address: CERS ID: <br /> 1756 N WILSON WAY, STOCKTON, CA 95205 10180819 <br /> Inspection Contact: Title: Phone: <br /> Ashish Boveja Owner (209)941-2246 <br /> Inspection Type: Program: <br /> ROUTINE INSPECTION-Operating Permit 2361 - UST FACILITY <br /> Consent For: Consent Given By: <br /> 0 Inspection 0 Photos 0 Samples Allyssa Delsied, Manager <br /> Service Technician Onsite: Exp.Date: Designated Operator: Exp.Date: <br /> David Winkler 03/31/2020 Zane Nimmo 02/25/2020 <br /> Service Technician Manufacturer's Training: <br /> TT 03/31/20; Incon, 11/30/20; OPW, 03/14/20;VMI, 11/10/19 <br /> CCR=Title 23 California Code of Regulations HSC=Health and Safety Code CFR=Code of Federal Regulations <br /> V=Violation R=Repeat violation COS=Corrected on site during inspection <br /> File Review <br /> 101 HSC 25284 Failed to obtain a permit to operate from the EHD including but not limited to unpaid permit fees ❑V ❑R ❑COS <br /> 102 HSC 25284(a)(3)(A)/(B) No written agreement between tank owner and tank operator to monitor the tank system ❑V ❑R ❑COS <br /> 103 HSC 25292.2,25299.30 Failure to submit and maintain complete and current financial responsibility documents ❑V ❑R ❑COS <br /> 104 CCR 2711 UST operating permit application for facility and tank information not submitted or current ❑V ❑R ❑COS <br /> 105 CCR 2632(d)(1), Failed to have an approved UST monitoring plan ■V ❑R ❑COS <br /> 2634(d) <br /> 106 CCR 2632(d)(2), Failed to have an approved UST response plan ❑V ❑R ❑COS <br /> 2634(e) <br /> 107 CCR 2632(d)(1)(C) Plot plan/site map not submitted or failed to completely show where monitoring is performed ❑V ❑R ❑COS <br /> 108 CCR 2637,2638(e), Failed to notify the EHD 48 hours prior to conducting testing ❑V ❑R ❑COS <br /> 2643(g) <br /> 109 CCR 2637(a-d),2712 Failed to test secondary containment,or failed to maintain test records for 36 months ❑V ❑R ❑COS <br /> 110 CCR 2637(e),2637(f) Failed to submit"Secondary Containment Testing Report Form"within 30 days after the test ❑V ❑R ❑COS <br /> 111 CCR 2638(a)&(b), Failed to test monitoring and leak detection equipment annually ❑V ❑R ❑COS <br /> 26410) <br /> 112 HSC 25293 Failure to maintain UST records to enable the UPA to determine whether the UST is in compliance ❑V ❑R ❑COS <br /> 113 CCR 2638(c),2638(d) Failure to submit"Monitoring System Certification Form"within 30 days of completion of the test ❑V ❑R ❑COS <br /> 114 CCR 2636(f)(3),2643(c) No 0.1 gph annual line integrity test for pressurized piping,or within 30 days after repair ❑V ❑R ❑COS <br /> (3) <br /> 115 CCR 2715(a)(1)(B), "Designated Underground Storage Tank Operator Identification Form"not submitted within 30 days ❑V ❑R ❑COS <br /> 2715(a)(3) <br /> 116 CCR 2715 Designated operator,service tech or installer did not possess current ICC certification ❑V ❑R ❑COS <br /> 117 CCR 2663, 2712(b)(6) Failure to comply with tank lining,recordkeeping,and inspection requirements ❑V ❑R ❑COS <br /> 118 CCR 2715(a)(1)(A), Failure to submit the"Underground Storage Tank Statement of Understanding and Compliance Form" ❑V ❑R ❑COS <br /> 2715(a)(2) <br /> 119 HSC 25299(a)(8), Documents were falsified or misrepresented ❑V ❑R ❑COS <br /> 25299(b)(7) <br /> 120 CCR 2635(d) Failed to submit UST Certification of Installation/Modification ❑V ❑R ❑COS <br /> 121 CCR 2712(f) Failed to submit a written response within 30 days of receiving an inspection report ■V ❑R ❑COS <br /> 122 CCR 2631,2640.1, Failure to submit and/or maintain documentation regarding compatibility for UST system components ❑V ❑R ❑COS <br /> 2665,2711 <br /> FA0001858 PR0231300 SCO01 06/06/2019 <br /> EHD 23-01 Rev.09/28/2018 Page 1 of 5 Underground Storage Tank Program OIR <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />