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u` EK u J kt7; <br /> ( 7 rs <br /> SAN J a A n U I N Environmental Health Department <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Phone: Date: <br /> AISLE 1 #2356 (916) 373-3333 July 09 , 2019 <br /> Facility Address : CERS ID: <br /> 4219 E MORADA LN , STOCKTON , CA 95212 10185183 <br /> Inspection Contact: Title : Phone: <br /> Cindy Chheng Manager (209) 472-9842 <br /> Inspection Type: Program: <br /> ROUTINE INSPECTION - Operating Permit 2351 - UST FACILITY - 2481 COMPLIANT <br /> Consent For: Consent Given By: <br /> 0 Inspection ❑x Photos ❑x Samples Cindy Chheng , Manager <br /> Service Technician Onsite: Exp. Date: Designated Operator: Exp. Date: <br /> Brian Mcpheely 11 /09/2019 Samantha McMahan 10/19/2020 <br /> Service Technician Manufacturer's Training : <br /> VR , 02/27/20 , VMI , 11 /29/19 ; FF , 01 / 10/20 <br /> CCR = Title 23 California Code of Regulations HSC = Health and Safety Code CFR = Code of Federal Regulations <br /> V = Violation R = Repeat violation COS = Corrected on site during inspection <br /> File Review <br /> 101 HSC 25284; CCR Failed to obtain a permit to operate from the EHD including but not limited to unpaid permit fees Cl V ❑ R ❑ COS <br /> 2711 (d) <br /> 102 HSC 25284(a) (3)(A)/(B) No written agreement between tank owner and tank operator to monitor the tank system ❑ V ❑ R ❑ COS <br /> 103 HSC 25292. 2 , 25299 . 30 Failure to submit and maintain complete and current financial responsibility documents ■ 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 /> 12634 (d) <br /> 106 CCR 2632(d) (2) , Failed to have an approved UST response plan ❑ V ❑ R ❑ COS <br /> 2634 (e) <br /> 107 CCR 2632(d) , 2641 (h) , Plot plan/site map not submitted or failed to completely show where monitoring is performed ■ V ❑ R ❑ COS <br /> 2711 (a) <br /> 108 CCR 2637 , 2638(e) , Failed to notify the EHD 48 hours prior to conducting testing ❑ V ❑ R ❑ COS <br /> 12643 (g) <br /> 109 CCR 2637(a-d) , 2712 Failed to test secondary containment, or failed to maintain test records for 36 months ❑ V ❑ R ❑ COS <br /> 110 CCR 2637(e) , 2637 (f) Failed to submit "Secondary Containment Testing Report Form" within 30 days after the test ❑ V ❑ R ❑ COS <br /> 111 CCR 2638 , 26410) , Failed to test monitoring and leak detection equipment every 12 months ❑ V ❑ R ❑ COS <br /> 2715 (f) <br /> 112 HSC 25293 Failure to maintain UST records to enable the UPA to determine whether the UST is in compliance ❑ V ❑ R ❑ COS <br /> 113 CCR 2638(c) , 2638(d) Failure to submit "Monitoring System Certification Form" within 30 days of completion of the test ❑ V ❑ R ❑ COS <br /> 114 CCR 2636(f) (3) , 2643(c) No 0 . 1 gph annual line integrity test for pressurized piping , or within 30 days after repair ❑ V ❑ R ❑ COS <br /> (3) <br /> 115 CCR 2715 (a)(1 ) (B) , "Designated Underground Storage Tank Operator Identification Form" not submitted within 30 days ❑ V ❑ R ❑ COS <br /> 2715 (a) (3) <br /> 116 CCR 2715 Designated operator, service tech or installer did not possess current ICC certification ❑ V ❑ R ❑ COS <br /> 117 CCR 2663 , 2712(b) (6) Failure to comply with tank lining , recordkeeping , and inspection requirements ❑ V ❑ R ❑ COS <br /> 118 CCR 2715(a)(1 )(A) , Failure to submit the "Underground Storage Tank Statement of Understanding and Compliance Form" ❑ V ❑ R ❑ COS <br /> 2715 (a) (2) <br /> 119 HSC 25299(a) (8) , Documents were falsified or misrepresented ❑ V ❑ R ❑ COS <br /> 25299(b) (7) <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 /> FA0016523 PR0524617 SCO01 07/09/2019 <br /> EHD 23-01 Rev. 09/28/2018 Page 1 of 6 Underground Storage Tank Program OIR <br /> 1868 E . Hazelton Avenue I Stockton , California 952051 T 209 468-3420 1 F 209 464-0138 1 www. sjcehd . com <br />