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SANJ O 1` Q U I `IA,II, Environmental Health Department <br /> COUNTY <br /> Hazardous Materials Program Inspection Report <br /> Facility Name: Facility Address: Date: <br /> KWIK SERVE 950 W ELEVENTH ST, TRACY January 11, 2019 <br /> SUMMARY OF VIOLATIONS <br /> (CLASS I,CLASS II,or MINOR-Notice to Comply) <br /> Item# Remarks <br /> 5 HSC 25505(a)(1) Failed to complete and/or submit hazardous materials inventory for all reportable materials on site. <br /> The Hazardous Materials Inventory forms for all materials were not complete. Please lit the new federal hazard <br /> categories for each material listed in the inventory section. Please use an updated safety data sheet to add the new <br /> federal hazard categories to the materials. <br /> This information must be current and submitted as part of the business plan. <br /> This violation was corrected on site. <br /> This is a repeat violation, Class II. <br /> 6 HSC 25505(a)(2) Failed to complete and/or submit a site map with all required content. <br /> The site map was not submitted as part of the business plan.The return to compliance certificate was uploaded <br /> instead of a site map. Please upload an updated site map with all of the required elements. <br /> A site map shall contain a north orientation, loading areas, internal roads, adjacent streets, storm and sewer drains, <br /> access and exit points, emergency shutoffs, evacuation staging areas, hazardous material handling and storage <br /> areas, and emergency response equipment. If a site map element is not applicable for your facility then list it on the <br /> map and label as"NA".This violation was corrected on site. <br /> This is a minor violation. <br /> 7 HSC 25505(a)(3) Failed to establish and/or submit emergency response procedures for a release or threatened <br /> release. <br /> The emergency response procedures were not submitted. The site map, certification of financial responsibility, and <br /> a letter from the chief financial officer were uploaded in the emergency response section and contingency section. <br /> A business plan shall include the following emergency response procedures for a release or threatened release of <br /> hazardous materials, including, but not limited to,the following: <br /> -immediate notification of local emergency personnel and the Environmental Health Department(EHD) <br /> -procedures for the mitigation of a release or threatened release to minimize any potential harm or damage to <br /> persons, property, or the environment <br /> -evacuation plans and procedures, including immediate notice,for the site <br /> This violation was corrected on site. <br /> This is a repeat violation, Class II. <br /> Overall Inspection Comments: <br /> Complete and submit a copy of the Return to Compliance Certification form to the EHD with a statement <br /> documenting the corrective actions that have been or will be taken for each violation, and any supporting <br /> paperwork, by 2/1/2019 . <br /> Starting September 1, 2018, all in-office CERS help will be provided at EHD hourly rate ($152). To schedule an <br /> appointment, please call (209)468-3420. <br /> FA0006388 PR0520704 SCO01 01/11/2019 <br /> EHD 19-01 Rev.09/27/2018 Page 2 of 3 Hazardous Materials Program OIR <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />