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A N J O A Q U I Environmental Health Department <br /> COUNTY— <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Address: Date: <br /> LAKEWOOD CHEVRON 236 N HAM LN, LODI March 30, 2021 <br /> Other Violations <br /> 2010 See below Unlisted General violation ❑V ❑R ❑COS <br /> SUMMARY OF VIOLATIONS <br /> (CLASS I,CLASS II,or MINOR-Notice to Comply) <br /> Item# Remarks <br /> 208 CCR 2716(a-e) Failure to comply with the designated operator inspection requirements. <br /> OBSERVATION: Designated operator reports were not signed within the required time frame. <br /> -The 2/4/2021 designated operator report was not signed by the owner/operator. <br /> REGULATORY GUIDANCE:Within 48 hours of the completion of the designated UST operator visual inspection, <br /> the designated operator shall sign and provide the owner or operator with a copy of the inspection report. Within 72 <br /> hours of being provided a signed copy of the report,the owner or operator shall provide a description of each <br /> corrective action taken or to be taken and shall sign and date the report, acknowledging the identified compliance <br /> issues. <br /> CORRECTIVE ACTION: Ensure all designated operator inspection reports are completed and signed within the <br /> required time frame in the future. <br /> This is a minor violation. <br /> Overall Inspection Comments: <br /> Complete and submit a copy of the Return to Compliance Certification form to the EHD with a statement <br /> documenting the corrective actions that have been or will be taken for each violation, and any supporting <br /> paperwork, by 4/29/2021 . <br /> To minimize person to person contact EHD is choosing to write the name of person receiving the report instead <br /> of having them sign. Starting September 1, 2018, all in-office CERS help will be provided at EHD hourly rate <br /> ($152). To schedule an appointment, please call (209)468-3420. <br /> Documents provided during inspection: <br /> - Return to Compliance Certification and Corrective Action Statement form <br /> AFTER THE COMPLIANCE DATE, EHD WILL BILL FOR ALL TIME AND ACTIVITIES ASSOCIATED WITH BRINGING <br /> THIS FACILITY BACK INTO COMPLIANCE. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> Received by: Date: March 30, 2021 Inspector: Inspector Phone: <br /> Printed Name and Title: CAROL PRESTO, EH Specialist (209)616-3061 <br /> Shawn Sodhi, Manager <br /> FA0003711 PR0231333 SCO01 03/30/2021 <br /> EHD 23-01 Rev.9/16/2020 Page 4 of 4 Underground Storage Tank Program OIR <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />