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San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sigov.or,fq ehd <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Address: Date: <br /> Super Store Industries-Grocery Division 1 16888 McKinley Ave, Lathrop October 06,2017 <br /> SUMMARY OF VIOLATIONS <br /> (CLASS 1.CLASS ll,or MINOR-Notice to Comply) <br /> Item# Remarks <br /> 209 CCR 2715(c) Designated operator did not inspect all required items and/or the inspection reports not completed. <br /> The designated operator failed to document all the alarms from the attached alarm history on the October 2016 <br /> designated operator monthly inspection report and failed to check that they were responded to appropriately. The <br /> missing alarms include:All alarmed from the October monitoring certification . During the monthly inspection, the <br /> designated operator shall review the alarm history for the previous month, check that each alarm was documented <br /> and responded to appropriately, and attach a copy of the alarm history with documentation taken in response to any <br /> alarms to the monthly report. Ensure that designated operators performing monthly inspections at this facility are <br /> including all of the required information on the reports. <br /> This is a minor violation. <br /> Overall Inspection Comments: <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, by November 5, 2017 <br /> Please be aware that as of January 1, 2014, facility operators are required to upload the following UST program <br /> documents into the California Environmental Reporting System (CERS): UST Monitoring Site Plan, UST <br /> Certification of Financial Responsibility, UST Response Plan, UST Letter from Chief Financial Officer(if <br /> applicable), and the Owner Statement of Designated Operator Compliance. The UST Owner/Operator: Written <br /> Agreement, if applicable, can be stored at the facility or uploaded into CERS. <br /> AFTER THE COMPLIANCE DATE,EHD WILL SILL 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: October 06, 2017 Inspector: Inspector Phone: <br /> Printed Name and Title: CESAR RUVALCABA, EHS Trainee (209)953-6213 <br /> Scott Sommerfeld, Facilities Manager <br /> FA0003833 PR0232523 80001 1010612017 <br /> EHD 23-01 Rev.09122116 Page 4 of 4 Underground Storage Tank Program OIR <br />