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SAN JOAQUIN Environmental Health Department col I (jrt'Ut Underground Storage Tank Program Inspection Report Facility Phone: Date: Facility Name: a2 - 5 — Z CERS ID: Facility Address: S cyo At\) �cS(50%\0 rA Inspection Contact: Title: Phone: Inspection Type: Program: O r,►e O(ZD Consent For: Consent Given By: 0 Inspection ep hotos R�Sam les r' MC7h ;` x e Exp. Dom: Service Technician Onsite- " Exp. Date: Mqnle ignated Operator: 13` 2�S arrrQ Yv Y Y e tb ill 1210 e 6-Acw cal Service Technician Manufacturer's Training: �� y b 1 t 1 f 2 b • h� t-k,e = t u 13 ( 'L'1 • M 1 - 3 (� 2: - Vj- ( 1 k2634(d) le 23 California ode of Regulations HSC = Health-land Safety Code CFR = Code of ederal Regulations EHD= E ironmentHealth Department V =Violation R = Repeat violation cosC = Corrected on site during inspection File Review 25284; CCR Failure to obtain a permit to operate from the EHD including but not limited to unpaid permit fees ❑ V ❑ R COS (d) ❑ V ❑ R ❑ COS 2711 Failure to submit a complete and accurate application for a permit to operate a UST oV ❑ R ❑ COS 2635(f), 2636(c)(2) Failure to submit the UST Certification of Installation/Modification ❑ V oR ❑ COS 2632(d)(1), Failure to submit a complete and accurate UST Monitoring Plan d) ❑ V aR ❑ COS 632(d)(2), Failure to submit a complete and accurate UST Response Plan e) ❑ V aR ❑ COS k10 CCR 2632(d), 2641(h) Failure to submit and maintain a current facility plot plan / site map HSC 25292.2; CCR Failure to submit and maintain complete and current financial responsibility documents ❑ V nR COS 2711(a)(11) nV nR cGOS CCR 2620(b); HSC Failure to implement or maintain a written agreement between the UST owner and operator 25284(a)(3)CCR 2715(a)(1)(8), Failure to submit "Designated Underground Storage Tank Operator Identification Form" within 30 days n V ❑ R o GOS 2715(a)(3) 110 CCR 2715(a)(1)(A), Failure to submit the "Underground Storage Tank Statement of Understanding and Compliance Form aV oR nCOS 2715(a)(2) 111 CCR 2637, 2638(e), Failed to notify the EHD 48 hours prior to conducting testing n V n R c COS 2643(g) 112 CCR 2638, 2641(j), Failure to have properly qualified service technician test leak detection equipment every 12 months ❑ V ❑ R nCOS 2715(f) ❑ V nR nCOS 113 CCR 2637(a-d), 2712(b) Failure to conduct secondary containment testing (1)(F) 114 1 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 OR nGOS 115 CCR 2638(c), 2638(d) Failure to submit "Monitoring System Certification Form" within 30 days of completion of the test = V = R 0 COS 116 CCR 2637.1(d), Failure to submit the "Spill Container Testing Report Form" within 30 days 2637.1(e) 117 CCR 2637(e), 2637(f) Failed to submit "Secondary Containment Testing Report Form" within 30 days after the test n R = CO: 118 CCR 2637.2(d&e), Failure to submit the "Overfill Prevention Equipment Inspection Report Form" within 30 days c R z CO 2665(a&b) 119 CCR 2663, 2712(b)(6) Failure to comply with tank lining certification, testing, inspection, and record requirements V la R to GC 120 CCR 2631 , 2640.1 , Failure to submit and/or maintain documentation regarding compatibility for UST system components ❑V OR O C( 2665, 2711 Page 1 of 4 UndeWw*4 StorWe To* Prograr 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjgoV,0t—W'EHD