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S A N J 0 A Q I I I Irl Environmental Health Department <br /> CCUNT <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Address: Date: <br /> CHEVRON STATION#210997* 1442 Colony Dr, RIPON January 12, 2022 <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 /> 117 CCR 2637(e), 2637(f)Failed to submit"Secondary Containment Testing Report Form"within 30 days after the test. <br /> OBSERVATION: Secondary containment testing was performed on 6/102021 and a test report was submitted on <br /> 7/12/2021,2 days 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 /> 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 2/12/2022 . <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: Official Inspection Report, Return to Compliance Certification, Free <br /> CUPA Classes Brochure <br /> ********Note <br /> - Spill container testing was partially observed. <br /> -The monitoring panel is listed on the monitoring plan as TLS 350 but on site was observed to be TLS 350 Plus <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: January 12, 2022 Inspector: Inspector Phone: <br /> Printed Name and Title: KRISTINA SAETERN, EH Specialist (209)616-3045 <br /> Email to Karina Gordillo, Site Manager <br /> FA0013918 PR0518458 SCO01 01/12/2022 <br /> EHD 23-01 Rev.12/06/2021 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 />