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S Q N O Q Q N Environmental Health Department C 0( ; N T 1 Underground Storage Tank Program Inspection Report Facility Name: Facility Phone: Date: PARKWOODS GAS& FOODi(M9) )Y W01 1M,)j FaVlhy Address: CERS ID: 1612 W H,�MMER LN STOCKTON CA 95209 1r)181241 Inspection Contact: 'Title: Phone: Emailed to Jesse Tiwana Manager 209 482-2580 Inspection Type; Program: Routine 2361 - UST FACILITY Consent For: Consent Given By: ■ Ins oti,�, ■ Photos 'Samples Stj ;mm Re es, Manager Service Technician Onslte: Exp.Date: Designated Operator: Exp.Date: Day 1�� \1'nhle 1/30/2026 David Winkler 2/22/2026 Service Technician INanufacturer's Troining: OUT=Violation R=Repeat Violation COS=Corrected on site during inspection 1 CA Health and Safety 2030021 -Facility has a valid Permit to Operate from the CUPA ❑OUT o R ❑COS Code 25284,CCR 2711 (d) 2 CA Code of Regulations 2010010-Complete and accurate UST Operating Permit Application has been ❑OUT ❑R o COS 2711 submitted. 3 CA Code of Regulations 2010013-Facility has submitted a complete and accurate UST Monitoring Plan. ■OUT ■R ❑COS 2632(d)(1), 2634(d) 4 CA Code of Regulations 2010014-Facility has submitted a complete and accurate UST Response Plan. ❑OUT ❑R ❑COS 2632(d)(2).2634(e) 5 CA Code of Regulations 2030041 -A current facility plot plan is maintained and has been submitted o OUT ❑R ❑COS 2532(d).2641(h) 6 ,CA Health and Safety 2010006-Owner/Operator has not made false statements,certifications,or ❑OUT ❑R o COS Code 25299(a)(8),25299 representations on documents (b)(7) 7 CA Code of Regulations 2010003-Owner/Operator submitted DO form and/or informed the CUPA of any ■OUT ■R o COS 2715(a)(1)(B),2715(a)(3) change(s)within 30 days(TCR 10) 8 CA Code of Regulations 2010016-"Underground Storage Tank Statement of Understanding and ❑OUT ❑R ❑COS 2715(a)(1)(A),2715(a)(2) Compliance Form"submitted(TCR 10) 9 CA Code of Regulations 2030002-Leak detection equipment tested by qualified service technician every ❑OUT ❑R ❑COS 2638,26416),2715(f) 12 months(TCR 9d) 10 CA Code of Regulations 2030074-Annual Monitoring System Certification Form to the CUPA within 30 ❑OUT ❑R ❑COS 2638(c),2638(d) days of completion of the test 11 CA Code of Regulations 2030048-Sec containment testing conducted per requirements&records kept for ❑OUT ❑R ❑COS 2637(a-d),2712(b)(1)(F) 36 mths(TCR 9d) 12 1 CA Code of Regulations 2010009-Secondary containment test results submitted to the CUPA within 30 ❑OUT ❑R ❑COS 12637(e),2637(f) days after the test. 13 CA Code of Regulations 2010017-Spill bucket testing results submitted to the UPA within 30 days of testing ❑OUT ❑R ❑COS 2637.1(d),2637.1(e) 14 CA Code of Regulations 2010018-Overfill prevention equipment inspection report form submitted to the ❑OUT ❑R ❑COS 2637.2(d&e),2665(a&b) UPA within 30 days 15 CA Code of Regulations 2030042-Line integrity test completed on DW press piping every 12 mths if no tail ❑OUT ❑R ❑COS 2636(f)(3),2643(c)(3) safe/+shutdown(TCR 9d) 16 CA Code of Regulations 2030050-0.1 gph piping test conducted on SW suction systems every 36 mths ❑OUT o R ❑COS 2643(d),2661(f) and after piping repair(TCR 9d) 17 CA Code of Regulations 2030051 -0A gph piping test conducted on SW gravity systems every 24 mths and ❑OUT ❑R ❑COS 2643(e),2661(f) after piping repair(TCR 9d) 18 CA Code of Regulations 2030029-Tank lining inspected wfin 10 years of lining,every 5 years after,cert o OUT ❑R o COS 2663, 2712(b)(6) submitted to CUPA(TCR 9c) EHD-CUPA Inspection Report IS01 Page 1 of 6 FA0003611 PRO231127 4513852 5/30/2025 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD