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Environmental Health Department SAN OAQUIN � V Y. xr - . Facility Name: Facility Phone: Date: FLAG CITY CHEVRON (209)334-1873 April 27,2023 Facility Address: CERS ID: 6421 CAPITOL AVE, LODI, CA 95242 101806Q5 Inspection Contact: Title: Phone: Kiumars Khajevandi Manager (209)481-8180 TInspection Type: Program: ROUTINE INSPECTION-Operating Permit 12361 -UST FACILITY Consent For: Consent Given By: 0 Inspection 0 Photos 0 Samples Kiumars Khajevandi,Manager Service Technician Onsite: Exp.Date: Designated Operator: Exp.Data: Edward Stearns 11/05/2024 Alex Jabbari 08/18/2024 Service Technician Manufacturer's Training: OPW,03/10/24;VR,07/31/24;VMI, 07/23/23 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 101 HSC 25284;CCR Failure to obtain a permit to operate from the EHD including but not limited to unpaid permit fees o V o R o COS 2711(d) 102 CCR 2711 Failure to submit a complete and accurate application for a permit to operate a UST a V o R o COS 103 CCR 2635(f),2636(c)(2) Failure to submit the UST Certification of Installation/Mod if cation a V o R o COS 104 CCR 2632(d)(1), Failure to submit a complete and accurate UST Monitoring Plan o V o R o COS 2634(d) 105 CCR 2632(d)(2), Failure to submit a complete and accurate UST Response Plan o V o R o COS 2634(e) 106 CCR 2632(d),2641(h) Failure to submit and maintain a current facility plot plan/site map ■V o R o COS 107 HSC 25292.2;CCR Failure to submit and maintain complete and current financial responsibility documents a 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 o V o R o COS 125284(a)(3) 109 CCR 2715(a)(1)(B), Failure to submit"Designated Underground Storage Tank Operator Identification Form"within 30 days o V o R o COS 2715(a)(3) 110 CCR 2715(a)(1)(A), Failure to submit the"Underground Storage Tank Statement of Understanding and Compliance Form" o V a R o COS 2715(a)(2) 111 CCR 2637,2638(e), Failed to notify the EHD 48 hours prior to conducting testing o V o R o COS 2643(g) 112 CCR 2638,26410), Failure to have properly qualified service technician test leak detection equipment every 12 months o V o R o COS 2715(f) 113 CCR 2637(a-d),2712(b) Failure to conduct secondary containment testing o V o R a 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 o V o R o COS (3) 115 CCR 2638(c),2638(d) Failure to submit"Monitoring System Certification Form"within 30 days of completion of the test o 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 o COS 2637.1(a) 117 CCR 2637(e),2637(f) Failed to submit"Secondary Containment Testing Report Form"within 30 days after the test o V o R o COS 118 CCR 2637.2(d&e), Failure to submit the"Overfill Prevention Equipment Inspection Report Form"within 30 days o V o R o COS 2665(a&b) 119 CCR 2663, 2712(b)(6) Failure to comply with tank lining certification,testing,inspection,and record requirements o V o R o COS 120 CCR 2631,2640.1, Failure to submit and/or maintain documentation regarding compatibility for UST system components o V o R o COS 2665,2711 FA0000485 PR0231706 SCO01 04/27/2023 EHD 23-01 Rev,12/06/2021 Page 1 of 6 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.sjgov.org/EHD