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Joaquinmr San Environmental Health -._ Hazelton1868 East • •,California95205-6232 Underground ; • w♦ Program Ins♦ • ' Report Facility Name: Exp. Date: Designated operator: Facility Phone: ❑ R Date: Yrrf tK ,rti_ �). a'`A 4r°, Service Technician Manufacturer's Training: 21.�r�1' �,r., 9` �i-14 ❑ R NJ aY 0 0 16 Facility Address: HSC 25292.2 Current financial responsibility documents not submitted ❑ V CCR = California Code of Regulations£ MSC = Health and CERS ID: 104 CCR 2711 UST Operating Permit Application for Facility and Tank information not submitted or current V = Violation R = Repeat violation COS = Corrected on site during inspection ❑ COS Insp tion contact. File Review Title: ❑ V ❑ R Phone: 106 CCR 2632 Monitoring and response plans not current or approved by the EHD rph ■ R U Inspection Type: CCR 2632(d)(1)(C) Plot plan/site map not submitted or failed to completely show where monitoring is performed Program. ❑ R 11',gig 4x5£ � _ , ��.+. 3' ?_...... _ , , *, ,....� i.i i s''2 ,, r � {17, CCR 2637(f), 2638(e) 23 1 ) ;..... 1, y E l_? ❑ R Consent For: 109 Consent Given By: Failed to test secondary containment ■ V ❑ R >L! Insvection izPhotos < Samples Ann /a : ti r ❑ V ❑ R Service Technician Onsite: Exp. Date: Designated operator: Exp. Date: ❑ R ❑ COS 102 HSC 25284(a)(3) Service Technician Manufacturer's Training: ❑ V ❑ R ❑ COS 103 HSC 25292.2 Current financial responsibility documents not submitted ❑ V CCR = California Code of Regulations£ MSC = Health and Safety Code CFR = Code of Federal Regulations 104 CCR 2711 UST Operating Permit Application for Facility and Tank information not submitted or current V = Violation R = Repeat violation COS = Corrected on site during inspection ❑ COS 105 File Review Current BOE number not submitted 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(f), 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 HSC 25284.2 Failed to test spill containers annually ❑ V ❑ R ❑ COS 113 CCR 2638(4) 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(a) 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 CCR 2712(f) Failed to submit a written response within 30 days of receiving an inspection report ❑ V ❑ R ❑ COS 126 HSC 25404(e)(4) Failed to report program data electronically ❑ V ❑ R ❑ COS