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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.sicehd.com <br /> Facility r Facility Inspection <br /> Name: ® Phon Date: <br /> Facility r CERS <br /> Address: Al. ID: <br /> Inspection TIP Phone: <br /> Contact: s� 1-801 <br /> Inspection o r ,l" !q® p g ` Program: <br /> Type: ® ->fVPA <br /> Consent Given For: Consent <br /> spection otos piing Given By: <br /> Service Tec Exp. yjK Designatede. Exp. <br /> Onsite: < / Date: Operator. p Date <br /> Service Technician <br /> Manufacturers Training: f J <br /> CCR=California Code of Regulations HSC=Health an Safe Code CFR=Code of Federal Regulations <br /> V=Violation R=Repeat COS=Corrected on site during inspection <br /> i <br /> 101 HSC 25284 No permit to operate(V650) ❑ ❑ ❑ <br /> 102 HSC 25284(a)(3) No written agreement between tank owner and tank operator to monitor the tank system(V735) ❑ ❑ ❑ <br /> 103 HSC 25292.2 Current financial responsibility documents not submitted(V720) ❑ ❑ ❑ <br /> 104 CCR 2711 UST Operating Pen-nit Application for Facility and Tank information not submitted or current(V651) ❑ ❑ ❑ <br /> 105 HSC 25286(c) Current BOE number not submitted(V652) ❑ ❑ ❑ <br /> 106 CCR 2632 Monitoring and response plans not current or approved by the EHD(V654) ❑ ❑ ❑ <br /> 107 CCR 2632(d)(1)(C) Plot plan/site map not submitted or failed to completely show where monitoring is performed(V655) ❑ ❑ ❑ <br /> 108 CCR 2637(f), Failed to notify the EHD 48 hours prior to conducting testing(V671) ❑ ❑ ❑ <br /> 2638(e) <br /> 109 CCR 2637 Failed to test secondary containment(V660) ❑ ❑ ❑ <br /> 110 CCR 2637(e) Failed to submit secondary containment test report within 30 days(\/662) ❑ ❑ <br /> 111 CCR 2638(a) Failed to test monitoring and leak detection equipment annually(V659) ❑ ❑ ❑ <br /> 112 HSC 25284.2 Failed to test spill containers annually(V661) ❑ ❑ ❑ <br /> 113 CCR 2638(d) Failed to submit monitoring system certification test report within 30 days(V823) ❑ ❑ ❑ <br /> 114 CCR 2636(f) Failed to perform 0.1 gph annual line test for pressurized piping without fail safe or shut down(V663) ❑ ❑ ❑ <br /> 115 CCR 2715(a) Failed to inform the EHD of a change of designated operator within 30 days(V658) ❑ ❑ ❑ <br /> 116 CCR 2715 Designated operator,service tech or installer did not possess current ICC certification(V717) ❑ ❑ ❑ <br /> 117 HSC 25292.5 Failed to conduct ELD testing on a system located within 1 000'of a public well(V672) ❑ ❑ ❑ <br /> 118 HSC 25292.5 Failed to repair and retest system due to failed ELD test(V749) ❑ ❑ ❑ <br /> 119 CCR 2644.1(a)(5) Failed to submit ELD test results within 60 days(V669) ❑ ❑ ❑ <br /> 120 CCR 2663 Failed to inspect a lined or repaired steel tank within 10 years of lining and every 5 years after(V666) ❑ ❑ ❑ <br /> 121 CCR 2663 Failed to submit tank lining certification within 30 days or to conduct proper tests(V667) ❑ ❑ ❑ <br /> 122 HSC 25299 Documents were falsified or misrepresented(V657) ❑ ❑ ❑ <br /> 123 CCR 2661 Permit to repair UST system not obtained(V673) ❑ ❑ ❑ <br /> 124 CCR 2635(d) Failed to submit UST Certification of Installation/Modification(\/840) ❑ ❑ ❑ <br /> 125 CCR 2712(f) Failed to submit a written response within 30 days of receiving an inspection report(V804) ❑ ❑ ❑ <br /> 126 HSC 25404(e)(4) Failed to report program data electronically(V817) ❑ ❑ ❑ <br /> Q S CCS <br /> 201 CCR 2712(b) Failed to maintain alarm logs and/or records of follow up actions(V725) ❑ ❑ ❑ <br /> 202 CCR 2712(b) Failed to maintain cathodic protection test records on site for at least 6 1/2 years(V733) ❑ ❑ ❑ <br /> 203 CCR 2712(b) Failed to maintain records of monitoring,repair,lining,and upgrades on site(V732) ❑ ❑ ❑ <br /> Receive Inspector. a Inspector. <br /> By(initi I)• a Phone: 0Q -gas sz- <br /> EHD 2 - 08/07/15 Kge 1 \_ -CST INSPECTION REPORT <br />