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SAN J O A O U I N Environmental Health Department Hazardous Materials Program Inspection Report Facility Name: COUNTRYSIDE LIQUORS&GAS Facility Phone: Date: Facility Address: (209)368-5380 April 06, 2018 14971 N HWY 88, LODI,CA 95240 cERs ID: Inspection Contact: 10180623 Aslf Khan Title: Phone: Cashier (� Inspection Type: Program: ROUTINE INSPECTION-Operating Permit 1921 -HMBP-Regular-Primary Location Consent For: Consent Given NT — 0 Ins emia0 Photos 0 Samples Asif Khan, Cashier CCR Cade of Regulations KSC=Health and Safety Catle CFR=Code w Federal Regulations V=Violation R=Repeat violation COS=Corrected on site during inspection Violations 1 SJO 4432 Failed to pay annual operating fees u n oCOS 2 HSC 25505,25508(a) Failed to complete and electronically submit a hazardous materials business plan (1) o V o R o COS 3 HSC 25507 Failed to establish and implement a hazardous materials business plan 0 a oC05 4 HSC 25508(a)(1) Failed to complete and/or submit the Business Activities or Owner/Operator Identification page in V o R in COS 5 HSC 25506(a)(1) Failed to complete and/or submit hazardous materials inventory for all reportable materials on site in oR oC05 6 HSC 25505(a)(2) Failed to complete and/or submit a site map with all required content o j oC05 7 HSC 25505(a)(3) Failed to establish and/or submit emergency response procedures for a release or threatened release •V oR oCOS 8 HSC 25505(a)(4) Failed to submit a training program or program is not reasonable or adequate for facility, o V o R o COS 9 HSC 25508(a)(1) Failed to annually review and certify that the business plan is complete,accurate,and up to date o V o R o COS 10 HSC 25508.1(a)-(1) Failed to submit revisions to business plan within 30 days of substantial change in operations a o oCOS 11 HSC 25505(a)(4) Failed to provide or document initial and/or refresher training to appropriate personnel •V o oCOS 12 HSC 25505(c) Failed to have the business plan readily available to facility or EHD personnel oV u oCOS 13 HSC 25505.1 Failed to notify property owner that facility is subject to and in compliance with the HMBP program oV OR oCOS 14 HSC 25505.1 Business on leased property failed to provide copy of HMBP Win 5 days of request by property,owner o V OR o COS 15 HSC 25510(a) Failed to report actual or threatened release to the EHD and/or CaIOES Warning Center o V o R o COS 16 HSC 25507.1 Failed to submit emergency response plan when not meeting Ag handler exemption requirements OV MR OCOS 17 HSC 25507.1 Failed to submit training program when not meeting Ag handler exemption requirements o V o R o COS 18 UHSC2552505,25507.2 Failed to establish and implement a HMBP when not meeting remote unstaffed facility exemptions o V o R o COS 19 511 Failed to submit a written response within 30 days of receiving an inspection report o V—.R o COS 1010low Unlisted Administretion/Documentation violation o V o R o COs 1020ow Unlisted Training violation o V o R o COS 1030low Unlisted Operations/Malntenance violation o V o R o COS 1040ow Unlisted Release/Leaks/Spills violation oV oR o COS 1045ow Unlisted Release/Leaks/Spills-Local Ordinance o V o R o COS 1050 ow Unlisted AbandonmenUlllegal Disposal/Unauthorized Treatment violation o V c R o COS 1055 ow Unlisted Abandonment/Illegal Disposal/Unauthorized Treatment-Local Ordinance o V o R o COS SUMMARY OF VIOLATIONS (CLASS I,CLASS II,or MINOR-Notice to Comply) FA0000540 PRO520827 SC001 04/062018 EHD 19-01 Rev.10/31/2017 Page 1 of Z 9 Hazardous Materials Program OR 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com