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''4jQl SAN J OAQ U I N Environmental Health Department <br /> ? r <br /> �1 6, —COUNTY- <br /> C, ► Gr-,7r-p<< +7r.,w< hPrf <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Phone: Date: <br /> AT&T California-UE020 (209)603-9726 February 11, 2019 <br /> Facility Address: CERS ID: <br /> 124 W Elm St, Lodi, CA 95240 10207012 <br /> Inspection Contact: Title: Phone: <br /> Thuy Tran Environmental site manage (209)474-4022 <br /> Inspection Type: Program: <br /> ROUTINE INSPECTION-Operating Permit 12361 -UST FACILITY <br /> Consent For: Consent Given By: <br /> ❑x Inspection x❑ Photos ❑x Samples I Thuy Tran, Environmental site manage <br /> Service Technician Onsite: Exp.Date: Designated Operator: Exp.Date: <br /> Gage Heart 06/12/2019 George Koffel 10/23/2019 <br /> Service Technician Manufacturer's Training: <br /> Veeder Root,07/06/19; SB,07/12/19 <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 o V o R o COS <br /> 102 HSC 25284(a)(3)(A)/(B) No written agreement between tank owner and tank operator to monitor the tank system o V o R o COS <br /> 103 HSC 25292.2,25299.30 Failure to submit and maintain complete and current financial responsibility documents o V o R o COS <br /> 104 CCR 2711 UST operating permit application for facility and tank information not submitted or current in V o R o COS <br /> 105 CCR 2632(d)(1), Failed to have an approved UST monitoring plan o V o R o COS <br /> 2634(d <br /> 106 CCR 2632(d)(2), Failed to have an approved UST response plan o V o R o 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 o V o R o COS <br /> 108 CCR 2637,2638(e), Failed to notify the EHD 48 hours prior to conducting testing n V o R o COS <br /> 2643(8) <br /> 109 CCR 2637(a-d),2712 Failed to test secondary containment,or failed to maintain test records for 36 months o V a R o COS <br /> 110 CCR 2637(e),2637(f) Failed to submit"Secondary Containment Testing Report Form"within 30 days after the test a V o R o COS <br /> 111 CCR 2638(a)&(b), Failed to test monitoring and leak detection equipment annually o V o R o COS <br /> 26410) <br /> 112 HSC 25293 Failure to maintain UST records to enable the UPA to determine whether the UST is in compliance n V o R o COS <br /> 113 CCR 2638(c),2638(d) Failure to submit"Monitoring System Certification Form"within 30 days of completion of the test in V o R o 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 o V a R o COS <br /> (3) <br /> 115 CCR 2715(a)(1)(B), "Designated Underground Storage Tank Operator Identification Form"not submitted within 30 days n V o R a COS <br /> 2715(a)(3) <br /> 116 CCR 2715 Designated operator,service tech or installer did not possess current ICC certification o V D R o COS <br /> 117 CCR 2663, 2712(b)(6) Failure to comply with tank lining,recordkeeping,and inspection requirements o V in R in COS <br /> 118 CCR 2715(a)(1)(A), Failure to submit the"Underground Storage Tank Statement of Understanding and Compliance Form" n V o R o COS <br /> 2715(a)(2) <br /> 119 HSC 25299(a)(8), Documents were falsified or misrepresented o V o R o COS <br /> 25299(b)(7) <br /> 120 CCR 2635(d) Failed to submit UST Certification of Installation/Modification o V o R o COS <br /> 121 CCR 2712(f) Failed to submit a written response within 30 days of receiving an inspection report n V o R o COS <br /> 122 CCR 2631,2640.1, Failure to submit and/or maintain documentation regarding compatibility for UST system components o V o R in COS <br /> 2665,2711 <br /> FA0003957 PR0231866 SC001 02/11/2019 <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 />