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RECEIVED FEB 0 6 2019 � o � .7 SAN 10AQUIN Environmental Health Department COUNTY � i � nfrl cz nrnvts hfIr) re Underground Storage Tank Program Inspection Report Facility Nama: Facility Phone: Date: CHEVRON STATION #209167 (209 ) 824-7433 February 06, 2019 Facility Address : CERS ID: 1234 E YOSEMITE AVE , MANTECA, CA 95336 10184299 Inspection Contact Title: Phone: Teresa Kennedy Manager (209) 824-7433 Inspection Type: Program: ROUTINE INSPECTION - Operating Permit 2361 - UST FACILITY Consent For: Consent Given By: 9 Inspection O Photos EI Samples Teresa Kennedy, Manager Service Technician Onslte: Exp. Date: Designated Operator. Exp. Date: Jesus Saldivar 06/ 16/2019 Rayana Black 01 /19/2020 Service Technician Manufacturer's Training: VMI , 11 /20/ 19; Veeder Root, 05/01 / 19; SB, 01131 /20 CCR = Title 23 California e of Regulations HSC = Health and Safety Code CFR = Code of Pederal Regulations V = Violation R = Repeal 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 a V o R o COS 102 HSC 25284 (a)(3)(A)I(B) No written agreement between tank owner and tank operator to monitor the tank system o V o R o COS 103 HSC 25292.2, 25299 .30 Failure to submit and maintain complete and current financial responsibility documents o V o R o COS 104 CCR 2711 UST operating permit application for facility and tank Information not submitted or current ❑ V o R o COS 105 CCR 2632(d)(1 ), Failed to have an approved UST monitoring plan ❑ V o R o COS 2634(d) 106 CCR 2632(d) (2), Failed to have an approved UST response plan o V o R ❑ COS 2634(e) 107 CCR 2632(d)(1 )(C) Plot plan/site map not submitted or failed to completely show where monitoring is performed ❑ V o R o COS 108 CCR 2637, 2638(e), Failed to notify the EHD 48 hours prior to conducting testing o V a R a COS 2643(9) 109 CCR 2637(a-d) , 2712 Failed to test secondary containment, or failed to maintain test records for 36 months o V o R ❑ COS 110 CCR 2637(e), 2637(() Failed to submit "Secondary Containment Testing Report Form" within 30 days after the test ❑ V ❑ R a COS 111 CCR 2638(a) d. (b) , Failed to test monitoring and leak detection equipment annually a V ❑ R ❑ COS 26410) 112 HSC 25293 Failure to maintain UST records to enable the UPA to determine whether the UST is in compliance c V ❑ R o COS 113 CCR 2638(c) , 2638(d) Failure to submit "Monitoring System Certification Form" within 30 days of completion of the test o V ❑ R o COS 114 CCR 2636(()(3) , 2643(c) No 0. 1 gph annual line Integrity test for pressurized piping, or within 30 days after repair o V o R o COS (3) 115 CCR 2715(a)(1 )(B) , "Designated Underground Storage Tank Operator Identification Form" not submitted within 30 days o V ❑ R o COS 2715(a)(3) 116 CCR 2715 Designated operator, service tech or Installer did not possess current ICC certification ❑ V o R ❑ COS 117 CCR 2663, 2712(b) (6) Failure to comply with tank lining, recordkeeping , and inspection requirements o V a R ❑ COS 118 CCR 2715(a)(1 ) (A) , Failure to submit the " Underground Storage Tank Statement of Understanding and Compliance Form" a V o R o COS 2715(a)(2) 119 HSC 25299(a)(8) , Documents were falsified or misrepresented o V ❑ R o COS 25299(b)(7) 120 CCR 2635(d) Failed to submit UST Certification of Installation/Modlfication Cl V o R ❑ COS 121 CCR 2712(() Failed to submit a written response within 30 days of receiving an Inspection report ■ V o R ❑ COS 122 CCR 2631 , 2640. 1 , Failure to submit and/or maintain documentation regarding compatibility for UST system components c V o R c COS 1266512711 FA0012532 PROS1624B SC001 02/06!2019 EHD 23,01 Rev 09/2812018 Page 1 of 4 Underground Storage Tank Program OIR 1868 E . Hazelton Avenue I Stockton , California 95205 ( T 209 468-3420 1 F 209 464-0138 I www. sjcehd corn