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t� 3 7JL7 3 RECEIVED FEB 191099 SAN JOAQUIN Environmental Health Department COUNTY A) TC _, t STr Underground Storage Tank Program Inspection Report Facility Name: Facility Phone: Date: CHEVRON STATION #372736/2223 (209 ) 474-9825 February 19, 2019 Facility Address: CERS ID: 9484 WEST LN , STOCKTON , CA 95210 10181655 Inspection Contact Title: Phone: Rosella Plummer Manager (209) 474-9825 Inspection Type: Program: ROUTINE INSPECTION " Operating Permit 2361 - UST FACILITY Consent For. Consent Given By: O Inspection Z Photos Z Samples Rosella Plummer, Manager Service Technician Onsite: Exp, Data: Designated Operator. Exp. Date: Jesus Saldivar 06/16/2019 Rayana Black 01 / 19/2020 Service Technician Manufacturer's Training: Veeder Root, 05/01 /19, VMI , 11 /20/19, SB , 01 /31 /20 CCR = Title 23 Caldomia Coda of Regulations HSC = Health and Safety Code CFR = Code o1 Federal Regulations V = Violation R = Repeat violation COS = Corrected on site during inspection File Review 101 HSC 25284 Failed to obtain a permit to operate from the EHD including but not limited to unpaid permit fees o V ❑ R ❑ COS 102 HSC 25284(a)(3) (A)/(B) No written agreement between tank owner and tank operator to monitor the tank system ❑ V ❑ R ❑ COS 103 HSC 25292. 21 25299. 30 Failure to submit and maintain complete and current financial responsibility documents ❑ V o R ❑ COS 104 CCR 2711 UST operating permit application for facility and tank information not submitted or current ❑ V ❑ R ❑ COS 105 CCR 2632(d)(1 ) 1 Failed to have an approved UST monitoring plan 2634(d) o V ❑ R ❑ COS 106 CCR 2832(d) (2), Failed to have an approved UST response plan 2634 (e) ❑ V o R ❑ COS 107 CCR 2632(d)(1 )(C) Plot plantsite map not submitted or failed to completely show where monitoring Is performed a V ❑ R ❑ COS 108 CCR 2637, 2638(e) , Failed to notify the EHD 48 hours prior to conducting testing ❑ V ❑ R ❑ COS 2643(8) 109 CCR 2837(aA), 2712 Failed to test secondary containment, or failed to maintain test records for 36 months ❑ V ❑ R ❑ COS 110 CCR 2637(e), 2637(f) Failed to submit "Secondary Containment Testing Report Form" within 30 days after the test ❑ V ❑ R ❑ COS 111 CCR 2638(a) 8 (b), Failed to test monitoring and leak detection equipment annually ❑ V o R o COS 26410) 112 HSC 25293 Failure to maintain UST records to enable the UPA to determine whether the UST is In compliance ❑ V ❑ R ❑ COS 113 CCR 2638(c) , 2638(d) Failure to submit "Monitoring System Certification Form" within 30 days of completion of the test ❑ V ❑ R ❑ COS 114 CCR 2638(0(3), 2643(c) No 0, 1 gph annual line integrity test for pressurized piping, or within 30 days after repair ❑ V ❑ R o COS (3) 115 CCR 2715(a)(1 ) (B), "Designated Underground Storage Tank Operator Identification Form" not submitted within 30 days ❑ V ❑ R o COS 2715 (a) (3) 116 CCR 2715 Designated operator, service tech or installer did not possess current ICC certification ❑ V ❑ R o COS 117 CCR 2663, 2712(b)(6) Failure to comply with tank lining, recordkeeping, and inspection requirements ❑ V ❑ R ❑ COS 118 CCR 2715(a)(1 )(A) , Failure to submit the "Underground Storage Tank Statement of Understanding and Compliance Form" ❑ V ❑ R ❑ COS .2715(a)(2) 119 HSC 25299(a)(8), Documents were falsified or misrepresented ❑ V o R o COS 25299(b) (7) 120 CCR 2635(d) Failed to submit UST Certification of Installation/Modification ❑ V ❑ R ❑ COS 121 CCR 2712(f) Failed to submit a written response within 30 days of receiving an inspection report ❑ V ❑ R ❑ COS 122 CCR 2631 , 2640. 1 ; Failure to submit and/or maintain documentation regarding compatibility for UST system components e V c R u COS 2665, 2711 FAD004525 PR0232601 SC001 02/19/2019 EHD 23-01 Rev 0928/2018 Page 1 of 6 Underground Storage Tank Program OIR 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468-3420 F 209 464. 0138 1 www sicehd Com w i