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San Joaquin County EnvironmentalDepartment 1868East Hazelton • 9 ` s A - Underground Storage i •i Inspection '! • Facility Narne: HSC 25284 Facility Phone: Date: INCa..fPi t .... `LwR JS, ., ett,.. ;.,€, HSC 25284(a)(3) '.::.0., 210 i5 Facility Address: ❑ V ❑ R ❑ COS CERS ID: FA(,�I'P,,A, F OA ` Current financial responsibility documents not submitted .3 i Inspection Contact: ❑ COS Title. CCR 2711 Phone• ❑ V ❑ R ❑ COS 105 Inspection Type: Current BOE number not submitted Program: ❑ V R6,.'U T! e�-4S P t._M,. ft\ ..i rLie fv-i, t.. nq 106 CCR 2632 Consent For: Consent Given By: ❑ R ❑ COS Inspection Edi Photos ZJ1 Samples CCR 2632(d)(1)(C) Keiii K'sP,flda, S::cr, tett ❑ V Service Technician Onsite: Exp. Date: Designated Operator: Exp. Date: Failed to notify the EHD 48 hours prior to conducting testing 01 1128/20 f i1C.'? Et, . x?.,'. s � i:i 1 i 1. ,'.i 6 Service Technician Manufacturer's Training I Or ince"".. 9,/21t ! \""liarr "'D12/1,9117Line i .`ate. , x4 . 91 16:i V = Violation R =Repeat violation COS = Corrected on site during inspection Fife Review 101 HSC 25284 No permit to operate ❑ V ❑ R ❑ COS 102 HSC 25284(a)(3) No written agreement between tank owner and tank operator to monitor the tank system ❑ V ❑ R ❑ COS 103 HSC 25292.2 Current financial responsibility documents not submitted ❑ V ❑ R ❑ COS 104 CCR 2711 UST Operating Permit Application for Facility and Tank information not submitted or current ❑ V ❑ R ❑ COS 105 HSC 25286(c) Current BOE number not submitted ❑ V ❑ R ❑ COS 106 CCR 2632 Monitoring and response plans not current or approved by the EHD ❑ V ❑ R ❑ COS 107 CCR 2632(d)(1)(C) Plot plan/site map not submitted or failed to completely show where monitoring is performed ❑ V ❑ R ❑ COS 108 CCR 2637(0,2638(e) Failed to notify the EHD 48 hours prior to conducting testing ❑ V ❑ R ❑ COS 109 CCR 2637 Failed to test secondary containment ❑ V ❑ R ❑ COS 110 CCR 2637(e) Failed to submit secondary containment test report within 30 days ❑ V ❑ R ❑ COS 111 CCR 2638(x) Failed to test monitoring and leak detection equipment annually ❑ V ❑ R ❑ COS 112 HSG 25284.2 Failed to test spill containers annually ❑ V ❑ R ❑ COS 113 CCR 2638(d) Failed to submit monitoring system certification test report within 30 days ❑ V ❑ R ❑ COS 114 CCR 2636(f) Failed to perform 0.1 gph annual line test for pressurized piping without fail safe or shut down ❑ V ❑ R ❑ COS 115 CCR 2715(x) Failed to inform the EHD of a change of designated operator within 30 days ■ V ■ R ■ COS 116 CCR 2715 Designated operator, service tech or installer did not possess current ICC certification ❑ V ❑ R ❑ COS 117 HSC 25292.5 Failed to conduct ELD testing on a system located within 1 000'of a public well ❑ V ❑ R ❑ COS 118 HSC 25292.5 Failed to repair and retest system due to failed ELD test ❑ V ❑ R ❑ COS 119 CCR 2644.1(a)(5) Failed to submit ELD test results within 60 days ❑ V ❑ R ❑ COS 120 CCR 2663 Failed to inspect a lined or repaired steel tank within 10 years of lining and every 5 years after ❑ V ❑ R ❑ COS 121 CCR 2663 Failed to submit tank lining certification within 30 days or to conduct proper tests ❑ V ❑ R ❑ COS 122 HSC 25299 Documents were falsified or misrepresented ❑ V ❑ R ❑ COS 123 CCR 2661 Permit to repair UST system not obtained ❑ V ❑ R ❑ COS 124 CCR 2635(d) Failed to submit UST Certification of Installation/Modification ❑ V ❑ R ❑ COS 125 i CCR 2712(f) Failed to submit a written response within 30 days of receiving an inspection report ❑ V ❑ R ❑ COS Received by (initial) Inspector: , s a S(--JoRE"'HS Phone: ( 09) 4,1-`i8-,',3 <.,_. Date: � 1, t'0/201 , Page 1 of 4