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<br /> San Joaquin County
<br /> Environmental Health Department
<br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232
<br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.si og v.org/ehd
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<br /> Facility Name: Facility Phone: Date:
<br /> CHEVRON#208117** (209) 830-0370 February 08, 2017
<br /> Facility Address: CERS ID:
<br /> 755 S TRACY BLVD, TRACY, CA 95376 10182313
<br /> Inspection Contact: Title: Phone:
<br /> Andrea Evans Store Manager () -
<br /> Inspection Type: Program:
<br /> ROUTINE INSPECTION -Operating Permit 2361 - UST FACILITY
<br /> Consent For: I Consent Given By:
<br /> ® Inspection ® Photos ❑ Samples I Andrea Evans, Store Manager
<br /> Service Technician Onsite: Exp.Date: Designated Operator: Exp.Date:
<br /> Darren A Sciume 06/09/2018 Derek Balonek 06/07/2018
<br /> Service Technician Manufacturer's Training
<br /> VR, 05/04/17; Spill Container Testing,10/06/19; LDT,10/02/19
<br /> CCR=California Codeo egu at{ons HSC=Health and SafetyCode CFR=Codeo a eral Regulations
<br /> V=Violation R=Repeat violation COS=Corrected on site during inspection
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<br /> 101 HSC 25284 No permit to operate ❑V ❑R ❑COS
<br /> 102 HSC 25284(a)(3) No written agreement between tank owner and tank operator to monitor the tank system ❑V ❑R ❑COS
<br /> 103 HSC 25292.2 Current financial responsibility documents not submitted ❑V ❑R ❑COS
<br /> 104 CCR 2711 UST operating permit application for facility and tank information not submitted or current ❑V ❑R ❑COS
<br /> 105 CCR 2632(d)(1) Failed to have an approved UST monitoring plan ❑V ❑R ❑COS
<br /> 106 CCR 2632(4)(2) Failed to have an approved UST response plan ❑V ❑R ❑COS
<br /> 107 CCR 2632(d)(1)(C) Plot plan/site map not submitted or failed to completely show where monitoring is performed ❑V ❑R ❑COS
<br /> 108 CCR 2637(f),2638(e) Failed to notify the EHD 48 hours prior to conducting testing ❑V ❑R ❑COS
<br /> 109 CCR 2637 Failed to test secondary containment ❑V ❑R ❑COS
<br /> 110 CCR 2637(e) Failed to submit secondary containment test report within 30 days ❑V ❑R ❑COS
<br /> 111 CCR 2638(a) Failed to test monitoring and leak detection equipment annually ❑V ❑R ❑COS
<br /> 112 HSC 25284.2 Failed to test spill containers annually ❑V ❑R ❑COS
<br /> 113 CCR 2638(d) Failed to submit monitoring system certification test report within 30 days ❑V ❑R ❑COS
<br /> 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
<br /> 115 CCR 2715(a) Failed to inform the EHD of designated operator identification or change within 30 days ❑V ❑R ❑COS
<br /> 116 CCR 2715 Designated operator,service tech or installer did not possess current ICC certification ❑V ❑R ❑COS
<br /> 117 CCR 2663 Failed to inspect a lined or repaired steel tank within 10 years of lining and every 5 years after ❑V ❑R ❑COS
<br /> 118 CCR 2663 Failed to submit tank lining certification within 30 days or to conduct proper tests ❑V ❑R ❑COS
<br /> 119 HSC 25299 Documents were falsified or misrepresented ❑V ❑R ❑COS
<br /> 120 CCR 2635(d) Failed to submit UST Certification of Installation/Modification ❑V ❑R ❑COS
<br /> 121 CCR 2712(f) Failed to submit a written response within 30 days of receiving an inspection report ❑V ❑R ❑COS
<br /> 122 CCR 26310) Failure to submit UST system component statement of compatibility for substance stored ❑V ❑R ❑COS
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<br /> 201 CCR 2712(b) Failed to maintain alarm logs and/or records of follow up actions ❑V ❑R ❑COS
<br /> 202 CCR 2712(b) Failed to maintain cathodic protection test records on site for at least 6 1/2 years ❑V ❑R ❑COS
<br /> 203 CCR 2712(b) Failed to maintain records of monitoring,repair, lining,and upgrades on site ❑V ❑R ❑COS
<br /> FA0007938 PR0508090 SCO01 02/08/2017
<br /> EHD 23-01 Rev.09/22/16 Page 1 of 4 Underground Storage Tank Program OIR
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