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SAN" J D�l+ �� I 11411" Environmental Health Department <br /> COUNTY— <br /> Underground <br /> �l O U N T Y-- <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Address: Tileptember <br /> ate: <br /> SHORT STOP FOOD MART 20 W TURNER RD LODI 03 2019 <br /> SUMMARY OF VIOLATIONS <br /> (CLASS I,CLASS II,or MINOR-Notice to Comply) <br /> Item# Remarks <br /> 320 CCR 2635, 2637.2, 2665, 2712 Failure to comply with the installation, inspection, or record keeping of the overfill <br /> prevention. <br /> Overfill prevention testing was conducted on March 05, 2019. This testing was required to be conducted by October <br /> 13, 2018. Ensure all future testing is conducted within required time frames. <br /> This is a Class II violation. <br /> Overall Inspection Comments: <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 10/3/2019. <br /> Starting September 1, 2018, all in-office CERS help will be provided at EHD hourly rate ($152). To schedule an <br /> appointment, please call (209)468-3420. <br /> Documents provided: <br /> -Return to compliance certification <br /> -Corrective Action Statement <br /> -EHD class schedule <br /> -Gasoline Advertising Signs <br /> -Certification of Financial Responsibility Form <br /> -Letter from Chief Financial Officer Form <br /> -Designated Understanding Storage Tank Operator Identification Form <br /> -Statement of Understanding and Compliance form <br /> AFTER THE COMPLIANCE DATE, EHD WILL BILL FOR ALL TIME AND ACTIVITIES ASSOCIATED WITH BRINGING THIS <br /> FACILITY BACK INTO COMPLIANCE. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> Received by: Date: September 03, 2019 Inspector: Inspector Phone: <br /> Printed Name and Title: SHEWIT WOLDEAREGAY, EH Specialist (209)468-0216 <br /> lena almanzar, manager <br /> FA0000645 PR0231380 SCO01 09/03/2019 <br /> EHD 23-01 Rev.08/27/2019 Page 7 of 7 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 />