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S A N J D AR I N Environmental Health Department <br /> TUU ;,�j 1 y <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Address: Date: <br /> Mossdale Chevron 444 W MOSSDALE RD, LATHROP June 28, 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 /> 107 HSC 25292.2; CCR 2711(a)(11)Failure to submit and maintain complete and current financial responsibility <br /> documents. <br /> 1)OBSERVATION: Financial responsibility documents have not been submitted to the EHD. The most recent <br /> financial responsibility documents in CERS are dated 06/15/2019. <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 /> 2)OBSERVATION: Current financial responsibility documents were not found on site. <br /> REGULATION GUIDANCE:A copy of current financial responsibility documents are required to be maintained on <br /> site. <br /> CORRECTIVE ACTION: Immediately obtain a copy of the facility's financial responsibility documents and maintain a <br /> copy on site. <br /> This is a minor violation. <br /> 118 CCR 2637.2(d&e), 2665(a&b) Failure to submit the"Overfill Prevention Equipment Inspection Report Form"within <br /> 30 days. <br /> OBSERVATION:An overfill prevention inspection was conducted on 01/10/2019 and a complete test report was not <br /> submitted. <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 repeat violation, Class II. <br /> FA0000212 PR0231692 SCO01 06/28/2021 <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 />