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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, California 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.s-gov.org/ehd/unibii.htmi <br /> CONTINUATION FORM Page: 3 of 4 <br /> OFFICIAL INSPECTION REPORT Date: 10/14/10 <br /> Facility Address: Circle K# 1205 16470 Cambridge Street, Lathrop Program: UST <br /> SUMMARY OF VIOLATIONS <br /> CLASS I,CLASS II,or MINOR-Notice to Comply) <br /> UST Inspection: Routine and annual Monitoring System Certification testing <br /> #4. Financial responsibility documents for the year 2010 have not been submitted to the EHD. Current <br /> financial responsibility documents are required to be submitted annually. Complete and submit a copy <br /> of the financial responsibility: Certification of Financial Responsibility and Letter from Chief Financial <br /> Officer by 11/15/10. CxYr.,kA Ovl k kc�lyQ?( ( p� <br /> #7. Secondary containment/SB 989 test results were not found on site. These records shall be kept on <br /> site for at least 3 years. Immediately locate and maintain the secondary containment system test results <br /> on site by 11/15/10. Ca rl-�C 06,i,�- Prt(" �'1 t'nW Grp; C""t rtLw <br /> # 23a. Changes in Designated Operator (DO) statement was not submitted. DO Rodolfo Tovar has <br /> performed monthly visual inspection report for the month of September 2010. DO Hakki Alduleme has <br /> performed monthly visual inspection reports for the months between January to August 2010. SJC EHD <br /> was received an Owner Statement of the changes in DO in April 2010 that Hakki Alduleme as the sole <br /> DO for this facility. Any changes of DO shall be reported to the EHD with 30 days. Submit notification to <br /> the EHD identifying all the designated operators for this facility by 11/15/10. <br /> # 23c. The DO failed to document all the alarms for the previous month and check that they were <br /> responded to appropriately on the February 2010 designated operator monthly inspection report. The <br /> missing alarm not documented for February 3, 2010 @ 5:33AM low liquid alarm on the sensor L5 91 <br /> annular. During the monthly inspection, the DO shall review the alarm history for the previous month, <br /> check that each alarm was documented and responded to appropriately, and attach a copy of the alarm <br /> history with documentation taken in response to any alarms to the monthly report. Ensure that DOs <br /> performing monthly inspections at this facility are including all of the required information on the reports. <br /> Submit a response action for the alarm that occurred on 02/03/10 to SJC EHD by 11/15/10. <br /> ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL eE BILLED AT THE CURRENT HOURLY RATE($122). <br /> THIS FACILITY IS SUBJECT TO REINSPECTI T ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD Inspectors Re ' y: re Title: <br /> vd", ha2 <br /> EHD 2302-003 Rev OHO CONTINUATION FORM <br />