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Un Joaquin Cou" MAR 2 3 2015 <br /> Environmental Health Department <br /> 1 8e8 East Hazelton Avenue, Stockton, California 95205..6232 <br /> Telephone:(209)468-3420 Fbx.-(209)468-3433 Web: J taiiiNVIRONMENTAL, <br /> (ira'.k1_71H,C-CPA7mmia X7 <br /> 1,10 Tt, Or <br /> Facility Nam: Facility Address: Data: <br /> CHEVRON STATION t209167 1234 E YOSEMITE AVE, MANTECA February 12,2016 <br /> Remarks <br /> 1 0 2637(e}Fait t0 submit secondary ant test report within 30 days. <br /> Secondary contain nt testing was performed an January 31,2014(SR0068278 related repairs)and a test report <br /> Was submitted on May 7.2014,three months late. A copy of the test report must be submitted within 30 days of the <br /> tests. Take all necessary precautions to ensure testing and submittal of test reports are performed in a timely <br /> manner.This is a Class 11 violation. <br /> Overall InSpection Comments: <br /> Complete and submit a copy of the Return to Compliance Certification form to the EMIR with a statement <br /> documenting the corrective actions that have been or will be taken for each violation, and any supporting <br /> paperwork,by March 14, 2015. <br /> Consent to perform the inspection,take photos and collect samples was given by Teresa Kennedy, the store <br /> manager. This facility's designated operator is Elijah Pendergraft(ICC expiration date: June 2, 2016) . The <br /> service technician onsite was Gilbert Garcia(ICC expiration date: July 11, 2015),who had the following <br /> manufacturer's certifications, VR: March 20, 2016 and VMI: March 15, 2015. <br /> Please be are that as of January 1, 2014,facility operators are required to upload the following UST program <br /> documents into the California Environmental Reporting System (CE ): LIST Monitoring Site Plan, UST <br /> Certification of Financial Responsibility, UST Response Plan, UST Owner/Operator-,Written Agreement(if <br /> applicable), UST Letter from Chief Financial Officer, and Owner Statement of Designated UST Operator <br /> Compliance. <br /> THEAMVE R17MD'DXTESWLt or,111mmArTHEVORRENTM011"mcm <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> - <br /> Rees Mr: <br /> W. rift <br /> inL <br /> Y-% <br /> it pector Phonw. <br /> ka" <br /> e" ek ELENA MANZO, RENS (209)953-7699 <br /> W <br /> Page 4 of 4 <br />