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RECEIVED Environmental Health Department SAN JDAHIN JUN 2 7 2023 ENVIRONMENTAL HEALTH Underground Storage Tank Program Inspection Report Facility Name: Facility Phone: Date: TIWANA GAS & FOOD (209 ) 477 -3111 June 05 , 2023 Facility Address: CERS ID: 1210 E HAMMER LN , STOCKTON , CA 95210 10181355 Inspection Contact: Title: Phone: Verinder Tiwana Environmental Contact (209) 298-6629 Inspection Type: Program: ROUTINE INSPECTION - Operating Permit 2361 - UST FACILITY Consent For: Consent Given By: >< Inspection Z Photos ❑ Samples Verinder Tiwana , Environmental Contact Service Technician Onsite: Exp, Date: Designated Operator: Exp. Date: David Winkler 01 /30/2024 Fernando Solis 04/05/2025 Service Technician Manufacturer's Training: VR , 02/07/24 ; VMI , 11 /08/23 ; OPW ( Bravo - 1 /26/2024 ) 103/10/24 CCR = Title 23 California Code of Regulations HSC = Health and Safety Code CFR = Code of Federal Regulations EHD = Environmental Health Department 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 ❑ V ❑ R ❑ 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 o COS 104 CCR 2632(d)( 1 ), Failure to submit a complete and accurate UST Monitoring Plan o V OR ❑ COS 2634(d) 105 CCR 2632(d)(2)4 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 o V o R ❑ COS 107 HSC 25292.2; CCR Failure to submit and maintain complete and current financial responsibility documents • V ■ R ❑ COS 2711 (a)(1 1 ) 108 CCR 2620(b); HSC Failure to implement or maintain a written agreement between the UST owner and operator ❑ V ❑ R a COS 125284(a)(3) 109 CCR 2715(a)(1 )(B), Failure to submit "Designated Underground Storage Tank Operator Identification Form" within 30 days ❑ V ❑ R o COS 2715(x)(3) 110 CCR 2715(a)(1 )(A), Failure to submit the "Underground Storage Tank Statement of Understanding and Compliance Form" a V ❑ R o COS 2715(a)(2) 111 CCR 2637 , 2638(e), Failed to notify the EHD 48 hours prior to conducting testing ❑ V OR ❑ COS 2643(8 112 CCR 2638, 26410), Failure to have property qualified service technician test leak detection equipment every 12 months ❑ V ❑ R ❑ COS 2715 113 CCR 2637(a-d), 2712(b) Failure to conduct secondary containment testing ❑ V ❑ R o 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 o COS 3 116 CCR 2638(c), 2638(d) Failure to submit "Monitoring System Certification Form" within 30 days of completion of the test ❑ V o R o COS 116 CCR 2637 . 1 (d), Failure to submit the "Spill Container Testing Report Form" within 30 days o V o 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 OR o COS 118 CCR 2637 .2(d&e), Failure to submit the "Overfill Prevention Equipment Inspection Report Form" within 30 days o V ❑ R o COS 12665(a&b) 119 CCR 2663, 2712(b)(6) Failure to comply with tank lining certification, testing , inspection , and record requirements o V OR o COS 120 CCR 2631 , 2640' ' 1 Failure to submit and/or maintain documentation regarding compatibility for UST system components o V ❑ R ❑ COS 2665, 2711 FA0003730 PR0231125 SCO01 06/05/2023 EHD 23.01 Rev, 12/06/2021 Page 1 of 6 Underground Storage Tank Program OIR 1868 E . I-lazelton Avenue I Stockton , California 95205 1 'T 209 468-3420 1 F 209 464-0138 1 www . sjgov , org /EHD