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A NJ O A Q U l N Environmental Health Department <br /> COUNTY— <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Address: Date: <br /> GSG GAS&MART 701 E DR MARTIN LUTHER KING JR BLVD, June 16, 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 /> 102 CCR 2711 Failure to submit a complete and accurate application for a permit to operate a UST. <br /> OBSERVATION: The UST Facility Operating Permit Application is lacking the California Department of Tax and Fee <br /> Administration (CDTFA) Underground Storage Tank Account Number.The listed CDTFA number(44051795)in <br /> CERS has been closed as of 5/12/2020. <br /> REGULATION GUIDANCE: The application for a permit to operate an underground storage tank shall include the <br /> CDTFA registration number issued to the owner of the tank, in accordance with HSC 25286. <br /> CORRECTIVE ACTION: Immediately log into the California Environmental Reporting System (CERS), update the <br /> required information, and submit for review by the EHD. <br /> This is a repeat violation, Class II. <br /> 107 HSC 25292.2; CCR 2711(a)(11)Failure to submit and maintain complete and current financial responsibility <br /> documents. <br /> OBSERVATION: Financial responsibility documents have not been submitted to the EHD. The most recent <br /> financial responsibility documents in CERS does not have new signatures and dates. <br /> -The Certificate of Financial responsibility dated 5/29/2021 was edited to type a new date on a previously submitted <br /> form and did not obtain new signatures. <br /> -The Letter from the Chief Financial Officer dated 2/17/2021 asset and liability amounts have not been re-evaluated <br /> since 2018 and was edited to type a new date on on a previously submitted form, new signatures were not obtained. <br /> REGULATION GUIDANCE: Current financial responsibility documents are required to be submitted annually. <br /> CORRECTIVE ACTION: Immediately log into the California Environmental Reporting System (CERS)at <br /> http://cers.calepa.ca.gov/, and upload the required documents. <br /> This is a repeat violation, Class II. <br /> 115 CCR 2638(c), 2638(d) Failure to submit"Monitoring System Certification Form"within 30 days of completion of the <br /> test. <br /> OBSERVATION:Annual monitoring system certification and leak detector testing was performed on 6/29/2020 and <br /> a test report was submitted on 8/17/2020, 1 month late. <br /> REGULATION GUIDANCE:A copy of the test report must be submitted within 30 days of the tests. <br /> CORRECTIVE ACTION: Take all necessary precautions to ensure testing and submittal of test reports are <br /> performed in a timely manner. <br /> This is a minor violation. <br /> FA0002512 PR0231059 SCO01 06/16/2021 <br /> EHD 23-01 Rev.9/16/2020 Page 4 of 6 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 />