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S0 JOA U 1 Environmental Health Department <br /> u ;N i Y I <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Address: Date: <br /> Supervalu 1990 N PICCOLI RD, STOCKTON November 20, 2019 <br /> Other Violations <br /> 2010 See below Unlisted General violation ❑V ❑R ❑COS <br /> SUMMARY OF VIOLATIONS <br /> (CLASS I,CLASS II,or MINOR-Notice to Comply) <br /> Item# Remarks <br /> 110 CCR 2637(e), 2637(f)Failed to submit"Secondary Containment Testing Report Form"within 30 days after the test. <br /> OBSERVATION:According to notifications sent to EHD and test records found onsite, a repair secondary <br /> containment testing was performed on 12/23/2019.A test report has not been submitted to the EHD or the <br /> California Environmental Reporting System (CERS). <br /> REGULATION GUIDANCE:A copy of the'Secondary Containment Testing Report Form'must be submitted within <br /> 30 days of the test. <br /> CORRECTIVE ACTION: Immediately provide this report to the EHD. <br /> This is a minor violation. <br /> 115 CCR 2715(a)(1)(B), 2715(a)(3)"Designated Underground Storage Tank Operator Identification Form"not submitted <br /> within 30 days. <br /> OBSERVATION: The Designated Underground Storage Tank Operator Identification Form was not found in CERS. <br /> REGULATION GUIDANCE: This form must be uploaded to the California Environmental Reporting System (CERS). <br /> The owner or operator shall submit a"Designated Underground Storage Tank Operator Identification Form" no later <br /> than 30 days after any change in the designated UST operator(s). <br /> CORRECTIVE ACTION: Immediately log into the California Environmental Reporting System (CERS)at <br /> http://cers.calepa.ca.gov and upload the Underground Storage Tank Statement of Understanding and Compliance <br /> Form for this facility. <br /> This is a repeat violation, Class II. <br /> 116 CCR 2715 Designated operator, service tech or installer did not possess current ICC certification. <br /> OBSERVATION: Designated operator, Erick Brown performed the 1/31/2020, 2/28/2020, 3/27/2020,4/24/2020, and <br /> 5/23/2020 inspections and did not have a current ICC certification at the time of the inspections. <br /> REGULATION GUIDANCE:A designated operator shall have a current ICC certification at the time of the <br /> inspections. <br /> CORRECTIVE ACTION: Ensure that any designated operator who performs inspections at this facility has current <br /> ICC certification and submit documentation to the EHD. <br /> This is a minor violation. <br /> FA0003826 PR0231820 SCO01 11/20/2019 <br /> EHD 23-01 Rev.9/20/2019 Page 4 of 6 Underground Storage Tank Program OIR <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />