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SAN J OAQ U I N Environmental Health Department <br /> COLJNTY <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name : Facility Phone: Date : <br /> MANTECA CHEVRON ( 925 ) 785 -2000 March 06 , 2019 <br /> Facility Address : CERS ID: <br /> 1490 S MAIN ST , MANTECA , CA 95337 0 <br /> Inspection Contact: Title: Phone: <br /> ANNIE GURPREET D SANDHU Tank owner ( 925 ) 785 -2000 <br /> Inspection Type: Program : <br /> ROUTINE SUPPLEMENTAL ACTIVITY - Operating Permit 12351 - UST FACILITY - 2481 COMPLIANT <br /> Consent For: I Consent Given By : <br /> I] Inspection Z Photos N Samples ANNIE GURPREET D SANDHU , Tank owner <br /> Service Technician Onsite: Exp. Date : Designated Operator: Exp. Date : <br /> Maxwell Hines 11 /09/2019 Nikola Zagorov 05/08/2019 <br /> Service Technician Manufacturer's Training <br /> OPW , 01 /01 /20 ; VMI , 07/ 13/20 , Veeder Root, 03/28/20 <br /> R = Title 23 California Code of Regulations HSC = Health and Safety Code CFR = ode 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 D V D R D 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 D COS <br /> 103 HSC 25292 . 21 25299 . 30 Failure to submit and maintain complete and current financial responsibility documents D V D R D COS <br /> 104 CCR 2711 UST operating permit application for facility and tank information not submitted or current D V D R D COS <br /> 105 CCR 2632(d) ( 1 ) , Failed to have an approved UST monitoring plan D V D R D COS <br /> 2634(d) <br /> 106 CCR 2632 (d) (2) , Failed to have an approved UST response plan D V D R D 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 D V D R D COS <br /> 108 CCR 2637 , 2638(e) , Failed to notify the EHD 48 hours prior to conducting testing D V D 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 D V D R D COS <br /> 110 CCR 2637(e) , 2637 (f) Failed to submit "Secondary Containment Testing Report Form" within 30 days after the test D V D R D COS <br /> 111 CCR 2638 (a) & (b) , Failed to test monitoring and leak detection equipment annually D V D R D COS <br /> 26410) <br /> 112 HSC 25293 Failure to maintain UST records to enable the UPA to determine whether the UST is in compliance D V D R D COS <br /> 113 CCR 2638(c) , 2638 (d) Failure to submit "Monitoring System Certification Form" within 30 days of completion of the test D V D R D COS <br /> 114 CCR 2636 (f) (3) 1 2643 (c) No 0 . 1 gph annual line integrity test for pressurized piping , or within 30 days after repair ❑ V D R D COS <br /> (3) <br /> 115 CCR 2715(a) ( 1 ) (B) , " Designated Underground Storage Tank Operator Identification Form" not submitted within 30 days D V D R D COS <br /> 2715(a) (3) <br /> 116 CCR 2715 Designated operator, service tech or installer did not possess current ICC certification D V D R D COS <br /> 117 CCR 2663 , 2712 (b) (6) Failure to comply with tank lining , recordkeeping , and inspection requirements D V D R D COS <br /> 118 CCR 2715(a) ( 1 ) (A) , Failure to submit the " Underground Storage Tank Statement of Understanding and Compliance Form" D V D R D COS <br /> 2715(a) (2) <br /> 119 HSC 25299(a) (8) , Documents were falsified or misrepresented D V ❑ R D COS <br /> 25299 (b) (7) <br /> 120 CCR 2635 (d ) Failed to submit UST Certification of Installation/Modification ❑ V ❑ R D COS <br /> 121 CCR 2712 (f) Failed to submit a written response within 30 days of receiving an inspection report D V D R D COS <br /> 122 CCR 26317 2640 . 11 Failure to submit and/or maintain documentation regarding compatibility for UST system components D V D R D COS <br /> 2665 , 2711 <br /> FA0023750 PRO541436 SCO02 03/06/2019 <br /> EHD 23-01 Rev. 09/28/2018 Page 1 of 4 Underground Storage Tank Program OIR <br /> 1868 E . Hazelton Avenue Stockton , California 95205 1 T 209 468- 3420 1 F 209 464 -0138 1 www , sjcehd. com <br />