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� SAN JOAQUIN COUNTY 9i171 9690 0935 0072 9733 22 ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, California 95205-6232- Telephone: 5205-6232Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.org/ehd COPY UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT Facility Kwik Serve Name: Facility 2501 Jackson Ave Escalon Address: , # Inspection Au 6 2014 Date: g , Facility Contact: Nofal Mohsin Title: Operator 101 Phone: 209-838-3971 Inspection Type: XRoutine XMonitoring System Certification E Installation E Complaint— ID#: E Other: (Authority HSC 25289) Nofal Mohsin Operator Consent for: Xlnspection XSampling XPhotos No written agreement between the person that the operating permit was issued to and the tank operator to monitor the tanks stem Granted by: Title: p Monitoring Panel: Veeder-Root TLS -350 Piping System: XPressurized E Suction E Gravity Overfill Prevention: XMechanical E Audible/visual UST 34 107 5 Plot plan/site map not submitted or fails to completely show where monitoring is performed 108 CCR 2637 Secondary containment: (a) test not performed; (e) test report not submitted within 30 days; (f) test notification not provided to the EHD at least 48 hours prior to conducting the test 109 X CCR 2638 Monitoring equipment certification: (a) not performed annually; (d) test report not submitted within 30 days; (e) test notification not provided to the EHD at least 48 hours prior to conducting an installation, repair, replacement, calibration, or certification 110 ---Product--- ---- 91 -octane ---- DSL----- - 87 -octane -- ------------- -------------- ------------- -------------- 113 ------------ -------------- Designated Karen Arnaiz Operator: Date: Exp. D Dat 5-31-2015 Violations: E M1 -Release Detection E M2 -Release Prevention D M3—Both On Site Service Eivind B Bye Technician: Y ICC Exp. Date: Manufacturer's 5-6-2016 Training: VR: 3-17-2016 VMI: 3-7-2016 Inspector. I Received By:Title: Elena Manzo (209) 953-7699 �k ( , �C� I EHD 23-02 Rev 04/19/12 Page 1 UST INSPECTION REPORT VIOLATIONS # I C1 I C2 M I Code Section HSC = California Health and Safety Code; CCR = Califomia Code of Regulations C1 = Class 1 violation; C2 = Class 2 violation; M = Minor violation Fit Re I>. 101 HSC 25284 No permit to operate 102 HSC 25404.5 Annual operating fees not paid 103 HSC 25284(a)(3) No written agreement between the person that the operating permit was issued to and the tank operator to monitor the tanks stem 104 HSC 25292.2 Current financial responsibility documents not on file with the Environmental Health Department (EHD) 105 X I CCR 2711 Current Unified Program Consolidated Forms not on file with the EHD (Facility and tank form) 106 X CCR 2632(b) Monitoring Program (Monitoring & Response Plans) is not current or approved by the EHD 107 CCR 2632(d)(1)(C) Plot plan/site map not submitted or fails to completely show where monitoring is performed 108 CCR 2637 Secondary containment: (a) test not performed; (e) test report not submitted within 30 days; (f) test notification not provided to the EHD at least 48 hours prior to conducting the test 109 X CCR 2638 Monitoring equipment certification: (a) not performed annually; (d) test report not submitted within 30 days; (e) test notification not provided to the EHD at least 48 hours prior to conducting an installation, repair, replacement, calibration, or certification 110 HSC 25291 (0 Annual line leak detector test not performed (M1) 111 HSC 25284.2 Annual spill containment testing not performed 112 CCR 2636(f)(4) Annual line tightness test not performed if positive shutdown or fail safe not present (M1) 113 CCR 2715(a) Failed to inform the EHD of a change of designated operator within 30 days 114 CCR 2715(b) Designated operator does not possess a current ICC CA UST System Operator certification 115 CCR 2660(k) Repair for tank or piping not tested for tightness after completion of the repair pursuant to (M2) permit conditions 116 HSC 25292.5 Enhanced leak detection (ELD) testing not performed on a system located within 1000' of public well, or failures not repaired and retested 117 X CCR 2661 Permit to repair UST system not obtained 118 HSC 25286(a) Operational permit not amended when UST storage and/or monitoring system changed 119 HSC 25298(b) Permit to temporarily close UST system not obtained 120 HSC 25298(c) Permit to close UST system not obtained 11111111111111 '10, 11Reo� 201 X CCR 2712(b) Maintenance & monitoring records not maintained 3 years, cathodic protection records for 6 Y2 years, written performance claims pertaining to release detection systems for 5 years, or records of repairs, linings, and upgrades for the life of the tank. Monitoring records include: (1) date and time of all monitoring or sampling; (2) monitoring equipment calibration and maintenance records; (3) results of any visual observations; (4) results of sample analysis performed a lab or in the field; (5) logs of all readings of gauges or other monitoring equipment, round water elevations, or other test results; 6 results of inventory readings and reconciliations 202 1 CCR 2712(i) Monitoring plan, response plan, and/or operating permit and all conditions not onsite 203 CCR 2650 Unauthorized release that: (c) did not escape secondary containment and cleaned up within eight hours (M1) was not recorded; (e) escaped secondary containment, not cleaned up after eight hours, or a sudden loss of product was not reported to the EHD within 24 hours Inspector. I Received By:Title: Elena Manzo (209) 953-7699 �k ( , �C� I EHD 23-02 Rev 04/19/12 Page 1 UST INSPECTION REPORT