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SAN J O Aq U I N Environmental Health Department <br /> tJ I\! I y <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Address: Date: <br /> CHEVRON STATION#201383 1960 W ELEVENTH ST,TRACY January 19, 2023 <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:An incomplete secondary containment test report dated 2/3/2022 was submitted to EHD on <br /> 2/15/2022 and a revision was requested on 4/29/2022.A complete and accurate test report was submitted to the <br /> EHD on 1/9/2023, 10 months 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 /> An inspection checklist was provided to the facility operator on the day of inspection (1/19/2023). A complete <br /> report was finished on (2/9/2023)and replaces the initial checklist. <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, within 30 days of receiving the complete inspection report. <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: February 09, 2023 Inspector: Inspector Phone: <br /> Printed Name and Title: SHEWIT WOLDEAREGAY, EH Specialist (209)616-3063 <br /> Emailed to Kathleen Matthews, Store Manager <br /> FA0004547 PR0232534 SCO01 01/19/2023 <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 />