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2019 - 06 - 13 130055 ENGINEER 2098253893 > > P 2 / 6 CEIVED S A N S A Q I N JUN 13 2019 Environmental Health Department LNVIIZONAIENFIAL HEAUINI-1 DEPARTAIEN > t. : . . : . i: i . : . .. :: '.: . . : . . :. . ;; . . : .� . aI1 : � a� ::. .. . : d . : . . . . :p . rr .. Focility Name: Facility Phone : DOte: KAISER FOUNDATION � MANTECA (209 825-3848 June 06 , 2019 Facility Address : CERS ID ; 1777 W YOSEMITE AVE , MANTECA, CA 95337 10181559 Inspection Contact: Title ; Phone : Sam Corbin Chief Engineer (2.09) 629-9919 InSpection Type : Program; ROUTINE INSPECTION it. Operating Permit 12361 - UST FACILITY Consent For Consent Given By: 21 Inspection F1 Photos IR sample Sant Corbin , Chief Ern itieer Servico Technician Onsito ; Exp. bate : D "Ignated Operator; Exp. Date : Jeffrey Baddors 05/29/2021 Mirk Rasmussen 12127/2019 Service Technician Manufacturer's Training! Veeder Root , 11119/20 ; Sia , 06/01 /21 CCR = Title. 23 Cnlifnrniea Cpde of Rrguialion; HSC = Hoalth and Safely code CFR 4, Code or Feddral Rogulnlians V -. Violation R. = Rcpprq vipl?tion CC6 = Correctod on site dunnp (ie , . evie it .. 1. . . . . . . . . . . .. . . . . . . . . . . . . . . 101 HSC 25264 Failed to obtain a permit to operate from the EHD including but not limited to unpaid permit fees u V R to COS 102 HSC 25284(s )(3)(A)/(B) No written agreement t)etweGn lank owner and tank operator to monitor the tank system n V n R n COS ~ 103 HSC 25992 .7 , 25299, 30 Failure to submit and maintain complete and current financial responsibility documonts � _ ww n V ri R u COS 104 CCR 2711 ,...., H GUST operating permit application for facility and tank information not submitted or current RV r R o COS 10S L342634 2632(d )( 1 ). ( Failed to have an approved UST monitoring pl3nie e V m R m COS d� 10E CCR 2632(d )(2) , Failed to have an approved UST response pian u V u R a COS 107 CCR 2632(d )( 1 )(C) Plot plan/slte 'map riot 3ubmitlod or failed to completely show where monitoring Is performed r1 V o R i:! COS 108 CON 7.637 , 2638(o), Failed to notify the EHD 48 hours prior to conducting testing Y~ µ - V o R r.1 COS 264 3 109 CCR 2637(a •d), 2712 Failed to test secondary contalnment, or failed to maintain test records for 36 months to V n R n COS 110 CCR 2637(e), 2637(f) ftailod to Submit "Secondary Containment Testing Report Form" within 30 days after the tort ., V R COS 111 CCR 2638(a ) & (b), Failed to test monitorine and leak detection etlulpment 2nnuolly w w VR c; COS 112 HSG 2.5293 Failure to malnt/,4In UST 1VcordS to enable the UPA to determine whether the UST is In compliance ^^ ,_I V n R r,i COS 113 CCR 2638(c), 2636 (d ) Failuro to submit "Monitoring System Certification Pnrm^ within 30 days of completion of the test o V u R n COS 114 CCR 2636(f)(3), 2643(c) No 0. 1 gph annual line Integrity test for prt,SSurizoll piping , or within 30 days after repair a V c R .a COS 115 CCR 271 $(a )( l )( 19 )1 " besignalod Undorground Storage Tank Operator Identification Form" not Submitted within 30 days z. V a R ;1 COS 2715(a)(3) 116 CCR 271 $ v Designated operator, service tech or installer did not possess current ICC cenificatlon :. V ~R '; COS 117 CCR 2663 , „2712(b )(6 ) Failure to comply with tank lining , recordkeeping , and Inspection requlrornents v ❑ R h COS — 118 CCR 2715(a )( 1 )(A), Failure toM submit the "Underground Storage Tank Statement of Understanding and Compliance Form,, ;a V TR ;a COS - -- 119 HSC 25299(3 )(6 ) , Ooeuments wore falsified or misrepresented V u R o COS 25299 h (7 120 CCR 2635(d ) Failed to submit UST Cerlifieatfon of Instollation/Modification —vT^Y l V , R i;. COS 121 CCR 2712 (f) Failod to submit a written response within 30 days of receiving an inspection report w c V ;.2R c! COS 122 CCR 2631 , 2640 . 1 , M U Failure to submit andjor mWntain documont6! tion regarding compatibility for UST system componenlS � � r, V F~ R :j COS 2665, 2711 FA000397d PRO'L22391 SCO01 06/06/2019 EHD 23-01 Rev. 09/20/2015 Page 1 of 5 Urdorground Ftcraga 'fank Program OIR 1868 E . Hazelton AvontJe I Stockton , California 952051 T 209 468- 34201 F 209 464-0138 ( www . sjcehd . corn Received Time Jun , 13 . 2019 1 : 48PM No . 5150