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Environmental Health Department <br /> SAN OAQ U IN <br /> ..,.,.... .. .-. ..._.. <br /> ,�E'Ea: <br /> adtr 'Tu . <br /> C°S C <br /> 3 <br /> Facility Name: Facility Address: Date: <br /> WOODBRIDGE AM PM" 18806 N LOWER SACRAMENTO RD, April 25, 2022 <br /> kIEEEEEE EFEF <br /> E <br /> E':'E'..:.,..,.,. _.<E..<.;.<..... .,_.............. <..P.P.EP,a.r� <br /> 404 CCR 2643(e),2661(f) Failure to conduct 0.1 gph test on single-walled gravity piping biennially or post repair(pre-1984) ❑V ❑R ❑COs <br /> E:E,EE <br /> ,. . .:.:.. ..., ... ........,, . . ......,.,_, <br /> �E <br /> 2010 See below Unlisted General violation ❑V ❑R ❑COS <br /> awk <br /> t 3t ¢ rrf t i <br /> B €€F�rEEEi E SSS SF , <br /> ..;'.. .: .... .. .......:. ....>,..> ....._... ..:a -t.E eEaE ..E......,.. ....< -. €..'�E':<...<.-.-.-.-.....,.s I E..< F a <br /> I <br /> Item# Remarks <br /> 109 CCR 2715(a)(1)(B), 2715(a)(3) Failure to submit"Designated Underground Storage Tank Operator Identification <br /> Form"within 30 days. <br /> OBSERVATION: A new designated operator,Amy Winkler, began conducting inspections on 611812021 and <br /> notifir_.atinn was not provided to the t=HD within 3p days of the change- <br /> REGULATION GUIDANCE:The owner or operator shall submit a"Designated Underground Storage Tank Operator <br /> Identification Form" no later than 30 days after any change in the designated UST operator(s)- <br /> CORRECTIVE ACTION: Immediately log into the California Environmental Reporting System(CERS)at <br /> http:llcers.calepa.ca.gov and upload the notification identifying all the designated operators for this facility. <br /> This is a minor violation. <br /> 122 CCR 2712(f) Failure to implement corrections and submit written response within 30 days of receiving the report. <br /> OBSERVATION: An inspection was last done on 4/26/2021 and an inspection report was issued identifying <br /> information to be submitted to bring this site into compliance. This information was required to be submitted by <br /> 512612021. This information was submitted late on 9/112021. <br /> REGULATION GUIDANCE:An operator that receives an inspection report shall have 30 days to implement the <br /> corrections specified in the inspection report and comply with permit conditions. The corrective action shall include <br /> all of the recommendations made in the report.The operator shall submit a written response that includes a <br /> statement documenting corrective actions taken or proposing corrective actions which will be taken. <br /> CORRECTIVE ACTION: Ensure that a written response documenting corrective actions taken or proposed is <br /> submitted and all corrections implemented within 30 days of receiving an inspection report. <br /> This is a Class II violation. <br /> FA0003B07 PR0232388 S0001 0412512022 <br /> EHD 23-01 Rev.12I061202f Page 4 of 7 Underground Storage Tank Program OtR <br /> 1868 E. Hazelton Avenue I Stockton,California 95205 1 T 209 468-3420� F 209 464-0138 1 ti,ww.sjgov.org/EHD <br />