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May 21 19 , 04 : 42p p . 2 IF { Anvironmen # [ Health Department IF - IF. bk . tF ,. to . _ . . . :3t I b+ .moyi'* .. r IF IF— it I IF IF I IF IF r Facility Name. WOQDBRIDGE AM PM Facility Phone: Dater Facility Address: 209 339-8238 A ril 09 2019 18806 N LOWER SACRAMENTO RD WOODBRIDGE , CA 95258 CERS ID: Inspection Cont acf Title: Phone: 10181237 Jassi Bola Owner 916 834-9436 Inspection Type: Program: ROUTINE INSPECTION to Operating Permit 2361 or UST FACILITY Consent For. Consent Given Sy: N Ins coon N photos 0 Samples Jassi Bola , Owner Service Technician Onsite: Exp. Date: Designated Operator: Exp. Date: Dave Winkler 01 /21 !2020 Ed Stearns 02/23/2020 Service Technician Manufacturer's Training Veeder-Root 02/018/2101;IIVMII 111291190 TT 3/31120; SB 11/09/19 CCR = Title 23 Ca6forrra Code or Regulations HSC = Healtif and afety Gods CFR = Code of Federal Regulations _ V = VoAtion R = Repeat violation COS = Corrected onsite during inspection FIFF IF IF. LIFF- _ _- . . 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 102 HSC 25284 (a)(3)(A)f No written agreement between tank owner and tank operator to monitorthe tank system :i V o R o COS (g, 103 HSC 25292. 21 25299.30 Failure to submit and maintain complete and current financial responsibility documents ■ V ❑ R o COS 104 CCR 2711 UST to permit application forfacility and tank information not submitted or current o V o R o COS 105 CCR 2632(d )(1 ), Failed to have an approved UST monitoring plan 2634(d) ■ V G R ci CDS 106 CCR 2632(d )(2), Failed to have an approved UST response plan 26341e 0V o R n COS 107 CCR 2632(d )( 1 )(C) Plot plan/site map not submitted or tailed to completely show where monitoring is performed V ❑ R o COS 108 CCR 2637, 2636(e), Failed to notify the EHO 48 hours prior to conducting testing o V o R o COS 2643(8) 109 CCR 2637(a-d), 2712 Failed to test secondary containment, or failed to maintain test records far 36 months ❑ V n R 7 COS 110 CCR 2637(e), 2637(f) Failed to Submit °Secondary Containment Testing Report Form" within 30 days after the toot U V ❑ R to COS 111 CCR 2638(a) & (b), Failed to test monitoring and teak detection equipment annually 26410) o V u R a COS 112 HSC 25293 Failure to maintain UST records to enable the UPA to determine whether the UST is in compliance c V a R n COS 113 CCR 2638(c), 2638(4) Failure to submit "Monitoring System Certification Form" within 30 days of completion of the test c V c R D COS 114 CCR 2636(t)(3)0 No 0. 1 gph annual line integrity test for pressurized piping, or within 30 days after repair o V o R c COS 2643(c)(3) FREE 115 CCR 2715(a)(1 )(13), "Designated underground Storage Tank Operator identscation Form" not submitted within 30 days o V it R a COS 2715(a)(3) 116 CCR 2715 Designated operator; service tech or installer did not possess current ICC certificationc V o R ❑ COS 117 CCR 2663, 2712(b)(6) Failure to comply with tank fining, recordkeeping, and inspection requirements ❑ V n R n COS 118 CCR 2715(a )(1 )(A), Failure to submit the 'Underground Storage Tank Statement of Understanding and Compliance Form" o V o R n COS 2715(a)(2) 119 HSC 25299(a)(8 ). Documents were falsified or misrepresented n V e R o COS 25299(b)(7) 120 CCR 2635(d) Failed to submit UST Certification of Installation/Modification = V ❑ R n COS FA0003607 P11102323B8 SC001 041OV419 EHD 23.Ot Rev. 0812812018 Page 1 of 6 Undergrounc Storage Tank Program OIR 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 468 -3420 I F 209 464-0138 1 www.Sjcehd. corn