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r <br />Page 1 of 7 <br />9171 9690 0935 0087 3059 72 <br />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sj og v.org/ehd <br />ksYg.r''}` < turas C�'at B bJv"z1:, -T.�'£" yt.. ! 51a++a�'y `. ,x`. l'eA, t .t.0 .�.; { eY"4, '+* <br />1ti^hs"�14.Pa*.}:A' �t,kf..NN,"t+ib{' }. ...'«UL ,b$7,. i,{ <br />Under round Stara eTank k ro raml`ns ect�41- <br />ion a ort <br />d , 3 }d' 1 $.yh; t'x'tii„ ,L4... <br />�r�tYi�t § h t i3. <br />Facility Name: <br />COUNTRY CLUB FOOD & FUEL MINI MART* <br />Facility Phone: <br />209 469-2000 <br />Date: <br />June 09 2016 <br />Facility Address: <br />1856 W COUNTRY CLUB BLVD STOCKTON CA 95204 <br />CERS ID: <br />10180831 <br />Inspection Contact: <br />Fahmi Al Sumeri <br />Title: <br />Owner <br />Phone: <br />209 <br />303-3783 <br />Inspection Type: <br />ROUTINE INSPECTION - Operating Permit <br />Program: <br />2361 - UST FACILITY <br />Consent For: <br />❑ Inspection ❑ Photos ❑Sam les <br />Consent Given By: <br />Service Technician Onsite: <br />Exp. Date: <br />Designated Operator: <br />Karen Arnaiz <br />Exp. Date: <br />05/05/2017 <br />Service Technician Manufacturer's Training <br />CCR = 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 />Fil Rev a <br />101 HSC 25284 <br />No permit to operate <br />■ V <br />❑ R <br />❑ COS <br />102 <br />HSC 25284(a)(3) <br />No written agreement between tank owner and tank operator to monitor the tank system <br />❑ V <br />❑ R <br />❑ COS <br />103 <br />HSC 25292.2 <br />Current financial responsibility documents not submitted <br />■ V <br />❑ R <br />❑ COS <br />104 <br />CCR 2711 <br />UST Operating Permit Application for Facility and Tank information not submitted or current <br />■ V <br />❑ R <br />❑ COS <br />105 <br />CCR 2632 <br />Monitoring and response plans not current or approved by the EHD <br />■ V <br />❑ R <br />❑ COS <br />106 <br />CCR 2632(d)(1)(C) <br />Plot plan/site map not submitted or failed to completely show where monitoring is performed <br />❑ V <br />❑ R <br />❑ COS <br />107 <br />CCR 2637(f), 2638(e) <br />Failed to notify the EHD 48 hours prior to conducting testing <br />❑ V <br />❑ R <br />❑ COS <br />108 <br />CCR 2637 <br />Failed to test secondary containment <br />■ V <br />❑ R <br />❑ COS <br />109 <br />CCR 2637(e) <br />Failed to submit secondary containment test report within 30 days <br />❑ V <br />❑ R <br />❑ COS <br />110 <br />CCR 2638(a) <br />Failed to test monitoring and leak detection equipment annually <br />■ V <br />❑ R <br />❑ COS <br />111 <br />HSC 25284.2 <br />Failed to test spill containers annually <br />■ V <br />❑ R <br />❑ COS <br />112 <br />CCR 2638(d) <br />Failed to submit monitoring system certification test report within 30 days <br />❑ V <br />❑ R <br />❑ COS <br />113 <br />CCR 2636(f) <br />Failed to perform 0.1 gph annual line test for pressurized piping without fail safe or shut down <br />❑ V <br />❑ R <br />❑ COS <br />114 <br />CCR 2715(a) <br />Failed to inform the EHD of designated operator identification or change within 30 days <br />❑ V <br />❑ R <br />❑ COS <br />115 <br />CCR 2715 <br />Designated operator, service tech or installer did not possess current ICC certification <br />❑ V <br />❑ R <br />❑ COS <br />116 <br />CCR 2663 <br />Failed to inspect a lined or repaired steel tank within 10 years of lining and every 5 years after <br />❑ V <br />❑ R <br />❑ COS <br />117 <br />CCR 2663 <br />Failed to submit tank lining certification within 30 days or to conduct proper tests <br />❑ V <br />❑ R <br />❑ COS <br />118 <br />HSC 25299 <br />Documents were falsified or misrepresented <br />❑ V <br />❑ R <br />❑ COS <br />119 <br />CCR 2635(d) <br />Failed to submit UST Certification of Installation/Modification <br />❑ V <br />❑ R <br />❑ COS <br />120 <br />CCR 2712(f) <br />Failed to submit a written response within 30 days of receiving an inspection report <br />❑ V <br />❑ R <br />❑ COS <br />09 <br />-'=ex a`.�''t <br />kx i. .,.ty �+.4.Rjm. :tG'.TS?ia't Y^�'.. t"2.,Lxt`'`,.'t' `,h'°it zy?a'{+ �! 'v"tsy.� .>t�fi' '�a <br />�Cn�Slte;:Recdrds� <br />qd <br />201 <br />JCCR 2712(b) <br />Failed to maintain alarm logs and/or records of follow up actions <br />■ V <br />❑ R <br />❑ COS <br />202 <br />CCR 2712(b) <br />Failed to maintain cathodic protection test records on site for at least 6 1/2 years <br />❑ V <br />❑ R <br />❑ COS <br />203 <br />CCR 2712(b) <br />Failed to maintain records of monitoring, repair, lining, and upgrades on site <br />❑ V <br />❑ R <br />❑ COS <br />204 <br />CCR 2712(i) <br />Current monitoring plan approved by the EHD not found on site <br />■ V <br />❑ R <br />❑ COS <br />Page 1 of 7 <br />9171 9690 0935 0087 3059 72 <br />