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SAN )O A Q U I N 7-5 I? Environmental Health Department COUNTY � l � lc7 r j Underground Storage Tank Program Inspection Report Facility Name: Facility Phone: Date: CHEVRON STATION#209167 (209)824-7433 February 01,2018 Facility Address: CERS to 1234 E YOSEMITE AVE,MANTECA,CA 95336 10184299 Inspection Contact Title: Phone: Teresa Kennedy Station manager (209)824-7433 Inspection Type: Program: ROUTINE INSPECTION-Operating Permit 2361-UST FACILITY Consent For. Consent Given By. ®Inspection ®Photos ®Samples Teresa Kennedy,Station Manager Service Technician Onsite: Exp.Date: Designated Operator: Exp.Date: Jesus Saldivar 06/16/2019 Elijah J Pendergraft 10/14/2019 Service Technician Manufacturer's Training: VMI, 11120/19,Veeder Root,05/01/19 CCR=Caldomia Code or Regulations HSC=Health and Safety Code CFR=Code of Federal Ragulatlons V-Violation R=Repeat violation COs=C"mded on site during inspection File Review 101 HSC 25284 Failure to obtain a valid permit to operate from the EHD Including but not limited to unpaid fees o V ❑R o COS 102 HSC 25284(a)(3)(A)/(B) No written agreement between tank owner and tank operator to monitor the tank system o V o R n COS 103 HSC 25292.2,25299.30 Current financial responsibility documents not submitted a V o R ❑COS 104 CCR 2711 UST operating permit application for facility and tank information not submitted or current o V o R o COS 105 CCR 2632(d)(1). Faded to have an approved UST monitoring plan a V o R ❑COS 2634(d) 106 CCR 2632(d)(2), Failed to have an approved UST response plan o V o R ❑COS 2634(e 107 CCR 2632(d)(1)(C) Plot planAfte map not submitted or failed to completely show where monitoring is performed o V o R ❑COS 108 CCR 2637(9,2638(x) Failed to notify the EHD 48 hours prior to conducting testing o V o R ❑COS 109 CCR 2637 Failed to test secondary containment o V a R o COS 110 CCR 2637(e) Failed to submit secondary containment test report within 30 days a V ❑R ❑COS 111 CCR 2638(a) Faded to test monitoring and teak detection equipment annually a V o R a COS 112 HSC 25284.2 Failed to last split containers annually u V o R it COS 113 CCR 2638(d) Failed to submit monitoring system certification test report within 30 days ■V o R o COS 114 CCR 2636(f) Failed to perform 0.1 gph annual fine test for pressurized piping without fail safe or shut down o V n R o COS 115 CCR 2715(a) Failed to submit to EHD notificatton of designated operator Identification or change whn 30 days o V ❑R o COS 116 CCR 2715 Designated operator,service tech or installer did not possess current ICC certification n V ❑R a COS 117 CCR 2663(h) Faded to inspect a lined or repaired steel tank within 10 years of lining and every 5 years after o V a R a COS 118 CCR 2663 Failed to submit tank fining certification within 30 days or to conduct proper tests ❑V o R o COS 119 HSC 25299(x)(8), Documents were falsified or misrepresented a V o R o COS 25299 120 CCR 2635(d) Faded to submit UST Certification of Installation/Modification a 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 a R a COS 122 CCR 2631 fl) Failure to submit and maintain UST system component statement of compatibility for substance stored a V o R a COS On Site Records 201 CCR 2712(b) Failure to maintain monkoring,rnalntenance,and follow up aclfon records �V . ❑COS FA0012532 PRO516248 Scoot 02101r2o18 EHD 23-01 Rev.10131 f2017 Page 1 of 4 Underground Storage Tank Program OIR 1868 E.HazeHon Avenue I Stockton,California 952051 T 209 468-34201 F 209 464-0138 1 www.sjcehd,com