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Ad&k Page 1 of 4 91719690 0935 0118 0896 80 W San Joaquin County Environmental Health Department 1868 East Hazelton Avenue, Stockton, California 95205-6232 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.org/�EELhd n1derground Storage Tank m lu, Progia Report r , Facility Name: KAISER FOUNDATION - MANTECA Facility Phone: (209) 825-3848 Date: July 08, 2016 Facility Address: 1777 W YOSEMITE AVE, MANTECA, CA 95337 CERS ID: 10181559 Inspection Contact: Sam Corbin Title: Chief Engineer —7(209) Phone: 629-9919 Inspection Type: ROUTINE INSPECTION - Operating Permit Program: 2361 - UST FACILITY Consent For: Z Inspection N Photos 21 Sample I Consent Given By: I Sam Corbin, Chief Engineer Service Technician Onsite: David Walker Exp. Date: 12/28/2017 Designated Operator: Gabriel Martin Exp. Date: 05/21/2018 Service Technician Manufacturer's Training VR:, 11/20/16-, VMI:, 02/02/17 CCR = Cafifornia Code of Regulations HSC = Health and Safety Code CFR = Code of Federal Regulations V = Violation R = Repeat violation COS = Corrected on site during inspectio File Review 101 HSC 25284 No permit to operate Li V o R o COS 102 HSC 25284(a)(3) No written agreement between tank owner and tank operator to monitor the tank system Fi V ii R Li COS 103 HSC 25292.2 Current financial responsibility documents not submitted m V o R ii COS 104 CCR 2711 UST operating permit application for facility and tank information not submitted or current ii V Ei R Li COS 105 CCR 2632(d)(1) Failed to have an approved UST monitoring plan ii V o R c COS 106 CCR 2632(d)(2) Failed to have an approved UST response plan Li V o R o COS 107 CCR 2632(d)(1)(C) Plot plan/site map not submitted or failed to completely show where monitoring is performed m V E R m COS 108 CCR 2637(f), 2638(e) Failed to notify the EHD 48 hours prior to conducting testing ci V Li R o COS 109 CCR 2637 Failed to test secondary containment ci V o R Ei COS 110 CCR 2637(e) Failed to submit secondary containment test report within 30 days Ei V o R o COS 111 CCR 2638(a) Failed to test monitoring and leak detection equipment annually o V o R D COS 112 HSC 25284.2 Failed to test spill containers annually o V o R i -i COS 113 CCR 2638(d) Failed to submit monitoring system certification test report within 30 days o V o R o COS 114 CCR 2636(f) Failed to perform 0.1 gph annual line test for pressurized piping without fail safe or shut down D V o R o COS 115 CCR 2715(a) Failed to inform the EHD of designated operator identification or change within 30 days ii V o R o COS 116 CCR 2715 Designated operator, service tech or installer did not possess current ICC certification Ei V Li R o COS 117 CCR 2663 Failed to inspect a lined or repaired steel tank within 10 years of lining and every 5 years after o V o R o COS 118 CCR 2663 Failed to submit tank lining certification within 30 days or to conduct proper tests o V o R Ei COS 119 j HSC 25299 Documents were falsified or misrepresented o V E:i R Ei COS 120 CCR 2635(d) Failed to submit UST Certification of Installation/Modification Ei V o R o COS 121 CCR 2712(f) Failed to submit a written response within 30 days of receiving an inspection report o V o R Ei COS 122 CCR 2631 Q) Failure to Submit UST system component statement of compatibility for substance stored Ei V Ei R o COS On Site Records 201 CCR 2712(b) Failed to maintain alarm logs and/or records of follow up actions Ei V D R o COS 202 CCR 2712(b) Failed to maintain cathodic protection test records on site for at least 6 1/2 years Li V Li R ii COS 203 CCR 2712(b) Failed to maintain records of monitoring, repair, lining, and upgrades on site Ej V c R o COS Page 1 of 4 91719690 0935 0118 0896 80