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,4,cF,`,,77 4L,,1 D San Joaquin County �x FSB 8 201 Environmental Health Department A N R, 1 200' 1868 East Hazelton Avenue, Stockton, California 95205-6232 Telephone.(209)468-3420 Fax:(209)468-3433 Web:www.sigov.org V1 ANT Al HE�LTH r �o n S#ark �T�n Pt`® s #ion apo. FacilityName: ac ty one: ate: CHEVRON STATION 4209167 (209)824-7433 February 07,2017 Facility Ad ress: CERS ID: 1234 E YOSEMITE AVE, MANTECA, CA 95336 1 10184299 Inspection Contact: Title: hone: Teresa Kennedy Manager (209) 824-7433 Inspection Type. rogram: ROUTINE INSPECTION-Operating Permit 12361 -UST FACILITY Consent or: Consent Given By: ®Ins ection ® Photos ®Samples Teresa Kennedy, Manager Service Technician Onslte Exp.Date: Designated Operator: Exp.Date: Darren Sciume 06/09/2017 Darek Balonek 06/07/2017 Service Technician Manu acturer-s ra n ng VR, 05/04117; LDT-5000, 10/09/19 CCR omsa Code ofRegulations HSC=Reiallh ana Safety Code CFR=Codeo ederal Regulations V=Violation R=Repeat violation COS=Corrected on site during inspection 101 NSC 25284 No permit to operate o V o R o COS 102 HSC 25284(a)(3) No written agreement between lank owner and tank operator to monitor the tank system o V ❑R o COS 103 HSC 25292.2 Current financial responsibility documents not submitted a V o R o COS 104 CCR 2711 UST operating permit application for facility and tank information not submitted or current ❑V o R ❑COS 105 CCR 2632(d)(1) Failed to have an approved UST monitoring pian o V o R o COS 106 CCR 2632(d)(2) Failed to have an approved UST response plan o V ❑R a COS 107 CCR 2632(d)(1)(C) Plot plan/site map not submitted or failed to completely show where monitoring is performed o V a R o COS 108 CCR 2637(f),2638(e) Failed to notify the EHD 48 hours prior to conducting testing ❑V o R o COS 109 CCR 2637 Failed to test secondary containment o V o R ❑COS 110 CCR 2637(e) Failed to submit secondary containment test report within 30 days a V a R ❑COS 111 CCR 2638(a) Failed to test monitoring and leak detection equipment annually o V a R o COS 112 HSC 25284.2 Failed to test spill containers annually o V o R a COS 113 CCR 2638(4) 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 o V a R o COS 115 CCR 2715(a) Failed to inform the EHD of designated operator identification or change within 30 days ❑V o R o COS 116 CCR 2715 Designated operator,service tech or installer did not possess current ICC certification o V o 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 o COS 119 HSC 25299 Documents were falsified or misrepresented o V o R o COS 120 CCR 2635(d) Failed to submit UST Certification of Installation/Modification a V o R ❑COS 121 CCR 2712(f) Failed to submit a written response within 30 days of receiving an inspection report o V o R ❑COS 122 CCR 26310) Failure to submit UST system component statement of compatibility for substance stored o V o R o COS 0601 m 201 CCR 2712(b) Failed to maintain alarm logs and/or records of follow up actions o V a R o COS 202 CCR 2712(b) Failed to maintain cathodic protection test records on site for at least 6 1/2 years o V ❑R ❑COS 203 CCR 2712(b) Failed to maintain records of monitoring,repair,lining,and upgrades on site ❑V o R o COS FA0012532 PRO516248 SCO01 02/07/2017 EHD 23-01 Rev.09/22/16 Page 1 of 4 Underground Storage Tank Program OIR