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A Q A n I Environmental Health Department Underground Storage Tank Program Inspection Report Facility Name: Facility Phone : Date : 7-ELEVEN INC #20632 ( 209 ) 952-3543 December 13 , 2022 Facility Address : CERS ID : 4627 DA VINCI DR, STOCKTON , CA 95207 10165883 Inspe„tion Contact: Title: Phope: N ; urs � nrie nv � rahrr�e► c� 1 �o o - � � tc S -yS �a Inspection Type: Program: ROUTINE INSPECTION - Operating Permit 2351 - UST FACILITY - 2481 COMPLIANT Consent For: Consent Given By: Inspection Photos Sam les Q $ I'iq Yl-! �l � A r(1 So Q Svove �" (7`Y\GL� E' r 'Service Technician Onsite: Fxp. Opts: Designated Operator: Exp . Date : d. C Ve. z3 Ser e jAe d s is ery ce Techni ian Manufacturer's Training : v I z vm I 2�- 1z3 a p l,U Z 1 CCR = Title 23 califorrfla Code of Regulations HSC = Health and Safely 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 XV ❑ R o 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 submit a complete and accurate UST Monitoring Plan ❑ V ❑ R ❑ COS 2634(d) 105 CCR 2632(d) (2) , Failure to submit a complete and accurate 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, inspection , and record requirements ❑ V ❑ R ❑ COS 120 CCR 2631 , 2640. 11 Failure to submit and/or maintain documentation regarding compatibility for UST system components ❑ V ❑ R ❑ COS 2665, 2711 FA0002541 PR0231074 SCO01 12/13/2022 EHD 23-01 Rev. 9/20/2019 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. sjcehd . com