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SAN JOAHI Environmental Health Department COUNTY Underground Storage Tank Program Inspection Report Facility Name: Facility Phone: Date: CHEVRON STATION 4372736/2223 (209)474-9825 February 11, 2021 Facility Address: CERS ID: 9484 WEST LN, STOCKTON, CA 95210 10181655 Inspection Contact: Title: Phone: Charles Bittle Environmental Contact (925) 842-9002 Inspection Type: Program: ROUTINE INSPECTION - Operating Permit 12361 - UST FACILITY Consent For: I Consent Given By: 0 Inspection 0 Photos 0 Sample I Delia Hermosillo, Store Manager Service Technician Onsite: Exp.Date: Designated Operator: Exp.Date: Jesus Saldivar 06/13/2021 Vivian Vargas 12/16/2021 Service Technician Manufacturer's Training VR, 04/28/21; VMI, 04/12/21; SB(OPW), 06/09/22 CCR=Title 23 California Code o Regulations HSC=Health and safety Code CFR=Code of Federal Regulations V=Violation R=Repeat violation COS=Corrected on site during inspection File Review 101 HSC 25284; CCR Failure to obtain a permit to operate from the EHD including but not limited to unpaid permit fees ❑V ❑R ❑COS 2711(d) 102 CCR 2711 Failure to submit a complete and accurate application for a permit to operate a UST ❑V ❑R ❑COS 103 CCR 2635(f),2636(c)(2) Failure to submit the UST Certification of Installation/Modification ❑V ❑R ❑COS 104 CCR 2632(d)(1), Failure to have an approved UST Monitoring Plan ❑V ❑R ❑COS 2634(d) 105 CCR 2632(d)(2), Failure to have an approved UST Response Plan ❑V ❑R ❑COS 2634(e) 106 CCR 2632(d),2641(h) Failure to submit and maintain a current facility plot plan/site map ❑V ❑R ❑COS 107 HSC 25292.2;CCR Failure to submit and maintain complete and current financial responsibility documents ❑V ❑R ❑COS 2711(a)(11) 108 CCR 2620(b); HSC Failure to implement or maintain a written agreement between the UST owner and operator ❑V ❑R ❑COS 25284(a)(3) 109 CCR 2715(a)(1)(B), Failure to submit"Designated Underground Storage Tank Operator Identification Form"within 30 days ❑V ❑R ❑COS 2715(a)(3) 110 CCR 2715(a)(1)(A), Failure to submit the"Underground Storage Tank Statement of Understanding and Compliance Form" ❑V ❑R ❑COS 2715(a)(2) 111 CCR 2637,2638(e), Failed to notify the EHD 48 hours prior to conducting testing ❑V ❑R ❑COS 2643(g) 112 CCR 2638,26410), Failure to have properly qualified service technician test leak detection equipment every 12 months ❑V ❑R ❑COS 2715(f) 113 CCR 2637(a-d),2712(b) Failure to conduct secondary containment testing ❑V ❑R ❑COS (1)(F) 114 CCR 2636(f)(3),2643(c) Failure to perform line integrity test every 12 months or within 30 days of repair of primary pipe ❑V ❑R ❑COS (3) 115 CCR 2638(c),2638(d) Failure to submit"Monitoring System Certification Form"within 30 days of completion of the test ❑V ❑R ❑COS 116 CCR 2637.1(d), Failure to submit the"Spill Container Testing Report Form"within 30 days ❑V ❑R ❑COS 2637.1(e) 117 CCR 2637(e),2637(f) Failed to submit"Secondary Containment Testing Report Form"within 30 days after the test ❑V ❑R ❑COS 118 CCR 2637.2(d&e), Failure to submit the"Overfill Prevention Equipment Inspection Report Form"within 30 days ❑V ❑R ❑COS 2665(a&b) 119 CCR 2663, 2712(b)(6) Failure to comply with tank lining certification,testing,and inspection requirements ❑V ❑R ❑COS 120 CCR 2631,2640.1, Failure to submit and/or maintain documentation regarding compatibility for UST system components ❑V ❑R ❑COS 2665,2711 FA0004525 PR0232601 SCO01 02/11/2021 EHD 23-01 Rev.9/16/2020 Page 1 of 4 Underground Storage Tank Program OIR 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD