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4Environmental Health Department <br /> SAW OAQUIN <br /> RIO <br /> Facility Noma; Facility Phone: Data: <br /> CHEVRON 352324 (209 ) 478-9293 June 18 , 2019 <br /> Facility Address: CERS to: <br /> 3304 W HAMMER LN , STOCKTON , CA 95219 10184253 <br /> Inspection Contact: Title : Phone: <br /> Yeasir Hugais Environmental Contact (650) 759-6248 <br /> Inspection Type: Program: <br /> ROUTINE INSPECTION - Operating Permit 2361 - UST FACILITY <br /> Consent For; Consent Given By; <br /> O Inspection O Photos 19 Sample Belall Hugais , Owner <br /> Service Technician Onsite: Exp, Date: Designated Operator: Exp. Date: <br /> Felix Ramirez 11 /09/2020 Zane Nlmmo 02/2512020 <br /> Service Technician Manufacturer's Training: <br /> OPW , 11 /29/20; VR , 07/08/19 ; VMI , 11 /17/19 <br /> CCR = Title 23 California Code of Regulations HSC = Health and Safety Code CFR = Code of Federal Reoulations <br /> V = Violation R = Repeat violation COS = Corrected on site during Inspection <br /> .�.- <br /> gS <br /> 35 <br /> 101 NSC 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)(Ay(B) No written agreement between tank owner and tank operator to monitor the tank system o V ❑ R c COS <br /> 103 HSC 25292. 2, 25299,30 Failure to submit and maintain complete and current financial responsibility documents a V c R c COS <br /> 104 CCR 2711 UST operating permit application for facility and tank information not submitted or current o V o R ❑ COS <br /> 105 CCR 2632(d )(1 ), Failed to have an approved UST monitoring plan a V o R ❑ COS <br /> 2634(d ) <br /> 106 CCR 2632(d)(2), Failed to have an approved UST response plan o V a R n 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 u V o R e COS <br /> 108 CCR 26370 2638(e), Failed to notify the EHD 48 hours prior to conducting testing c V e R ❑ COS <br /> 2643(g) <br /> 109 CCR 2637(a-d), 2712 Failed to test secondary containment, or faded to maintain test records for 36 months o V o R ❑ COS <br /> 110 CCR 2637(e), 2637(f) Failed to submit "Secondary Containment Testing Report Form" within 30 days after the test o V o R o COS <br /> 111 CCR 2638(a) & (b), Failed to test monitoring and leak detection equipment annually e V a 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 o V o R n COS <br /> 113 CCR 2638(c), 2638(d) Failure to submit "Monitoring System Certification Form" within 30 days of completion of the test a V o R ❑ COS <br /> 114 CCR 2636(0(3)0 2643(c) No 0. 1 gph annual line integrity test for pressurized piping, or within 30 days after repair c V o R in COS <br /> (3) <br /> 115 CCR 2715(a)( 1 )(B), "Designated Underground Storage Tank Operator Identification Form`' not submitted within 30 days o V o R n COS <br /> 2715(a)(3) <br /> 116 CCR 2715 Designated operator, service tech or installer did not possess current ICC certification o V ; o R o COS <br /> 117 CCR 2663, 2712(b)(6) Failure to comply with tank lining, recordkeeping, and inspection requirements c V o R u COS <br /> 118 CCR 2715(a)(1 )(A), Failure to submit the "Underground Storage Tank Statement of Understanding and Compliance Form" o V c 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 c R o COS <br /> 121 CCR 2712(() Failed to submit a written response within 30 days of receiving an inspection report o V c R o COS <br /> 122 CCR 2631 , 2640.1 , Failure to submit and/or maintain documentation regarding compatibility for UST system components o V c R c COS <br /> 2665, 2711 <br /> FA0012437 PRO516354 . SC601 06/18/2019 <br /> EHD 23,01 Rev. 09/2812018 Page 1 of 6 underground Storage Tank Program OIR <br /> 1868 E . Hazelton Avenue Stockton , California 952051 T 209 468-34201 F 209 464-0138 1 vA,vww.sjcehd . com <br />