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SAN JDA..i r Environmental Health Department Hazardous Materials Program Inspection Report Facility Name: Facility Phone: Date. COUNTRYSIDE LIQUORS 8 GAS (209) 368-5380 Apel 06, 2018 Facility Adtlnss:-'------- 14971 N HVJY 88 CERSID: LODI, CA 95240 _ 10180623 Inspection Contact Title: Phone: Asti Khan Cashier O _ Inspection Type: Program: ROUTINE INSPECTION - Operating Perin t 1921 - HMBP-Regular-Primary Location Consent For. I Consent Given 8y: OO Ins edion ❑ Photos n Sam les Asif Khan, Cashier CCR = Celdomie Code d Repuledons HSC = Health and Safety Code CFR = Cnda nl Federal RegulaLons v- Nolenon R = Repeai n.ian, i COS - Careved on sno dunng inspeceon MolallonS 1 SJO 4432 Failed to pay annuai op4raung fees 0V DR ,COS 2 HSC 25505, 25508(a) 1 Failed to complete and electronically submit a hazardous mateneis business pian o V DR n COS 3 HSC 25507 Failed Io esfaoish and iMplement a hazardous materials business pian o V DR q COS 4 HSC 25501 1) Failed to complete and/or submit the Business Activmes or OwnenOparstor Identification papa o V OR COS Failed to complete anogr submit hazardous materials inventory for a0 reportable materials an sue o V DR q COS 5 NSC 25506(a)(1) S HSC 25505(x)(2) Failed to complete andly submit a ate map With all required content q V DR d COS 7 HSC 25505(x)(3) Failed to establish andior submit emergency response procedures for a rebase or threatened rebase ■ V DR o COS a HSC 25505(x)(4) Failed to submit a traminp program or program is not reasonable or adequate for facility o V DR o COS Failed to annually review and certify that the business pian is complete, accurate, and up to elate 0 V o R o COS 9 HSC 25508(a)(1) 10 HSC 25508.1(11 Failed to aubmg revisions to business den within 30 days of substanual endings in operations a -V. R a COS 11 HSC 25505(6)(4) Failed to Provide or document initial andfor rexesher training to appropnate personnel _ •V 0R gC08 12 HSC 25505(0) Felled to have the business plan readily available to facility or EMD personnel It V n R o COS Failed to nouty property owner that facility is subject to and in compliance win the HMBP program p V o R n COS 13 HSC 25505.1 14 HSC 25505.1 Business on leased property failed to proviile copy of HMBP Win 5 drys of request by properly dReis, o V o R o.COS 15 HSC 25510(a) Faded to report actual or Mreatened lateness to me EHD and/or Ca OES Warning Center 0 V It R o,COS 18 HSC 25507.1 Failed to submit emergency response Plan when not meeting Ag handler exemption requirements o V DR mCOS 17 HSC 25507.1 Failed to submit training program when not meeting Ag handler exampbon requirements OV a R oICOS 18 HSC 25505, 25507.2 Failed to establish and implement a HMBP when not meting remote unstaffed facility exemptions OV a R o COS 19 HSC 25511 Faded to submit a written response month 30 days of receiving an inspection report OV a R a COS 1010 Sae below Unlisted Admimsuauon/Dodunentation violation o V o R o COS 1020 Baa below Unlisted Training violation o V a R c COS 1030 San below Unlisted OPeretioniumaintenance vhlaxon o V DR n COS 1040 Sees babes Unlisted Releaseltanks1pills violation a V o R D COS 1045 Sea below Unlisted ReeaselLenni1q;afis- Loral Ordinance 0V 0R or.OS 1050 See below _ Unlisted AbandommnNlljgal OsposallUnauthomied Treatment violation o V DR c COS 1055 See below Unlisted Abandommnulllegal DisposabUnauihonzed Tream ent - Loral Ordinanoe o V o R p Cas SUMMARY OF VIOLATIONS (CLASS I, CLASS N. or MINOR -Notal to Comply) EHD 1501 Rev. 1051,2017 1868 E. Hazekon Avenue j FA00(10.510 PROS20627 SCom 61/Otil2018 Page 1 of 2 Had ndous Maagls Progan DIR Stockt n, California 95205 1 T 209 468.34201 F 209 464-0138 1 w .sjcehd.com