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� • •Tref !• ft::� ,': San Joaquin County "' Environmental Health Department 1868 East Hazelton Avenue, Stockton, California 95205-6232 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd Facility Name: COUNTRY CLUB FOOD & FUEL MINI Facility Address: CERS ID: 1856 W COUNTRY CLUB BLVD STOCKTON CA 95204 1 10180831 Inspection Contact: Title: Phone: Ann/ Phil Elder Owner 209 662-0952 Inspection Type: Program: ROUTINE INSPECTION - ODeratina Permit 2361 - UST FACILITY Consent For: I Consent Given By: Service Technician Onsite: None Exp. Date: Designated Operator: Exp. Date: I Karen Arnaiz 05/05/2017 Service Technician Manufacturer's Training: CCR = California Code of Regulations HSC = Health and Safety Code CFR = Code of Federal Regulations V = Violation R =Repeat violation COS = Corrected on site during inspection 101 HSC 25284 No permit to operate ■ V ■ R ❑ COS 102 HSC 25284(a)(3) No written agreement between tank owner and tank operator to monitor the tank system ❑ V ❑ R ❑ COS 103 HSC 25292.2 Current financial responsibility documents not submitted ■ V ■ R ❑ COS 104 CCR 2711 UST Operating Permit Application for Facility and Tank information not submitted or current ■ V ■ R ❑ COS 105 HSC 25286(c) Current BOE number not submitted ❑ V ❑ R ❑ COS 106 CCR 2632 Monitoring and response plans not current or approved by the EHD ■ V ■ R ❑ COS 107 CCR 2632(d)(1)(C) Plot plan/site map not submitted or failed to completely show where monitoring is performed ❑ V ❑ R ❑ COS 108 CCR 2637(f), 2638(e) Failed to notify the EHD 48 hours prior to conducting testing ❑ V ❑ R ❑ COS 109 CCR 2637 Failed to test secondary containment ■ V ❑ R ❑ COS 110 CCR 2637(e) Failed to submit secondary containment test report within 30 days ❑ V ❑ R ❑ COS 111 CCR 2638(a) Failed to test monitoring and leak detection equipment annually ■ V ■ R ❑ COS 112 ( HSC 25284.2 I Failed to test spill containers annually I ■ V ■ R ❑ COS 113 CCR 2638(d) Failed to submit monitoring system certification test report within 30 days ❑ V ❑ R ❑ COS 114 CCR 2636(f) Failed to perform 0.1 gph annual line test for pressurized piping without fail safe or shut down ❑ V ❑ R ❑ COS 115 CCR 2715(a) Failed to inform the EHD of a change of designated operator within 30 days ❑ V ❑ R ❑ COS 116 CCR 2715 Designated operator, service tech or installer did not possess current ICC certification ❑ V ❑ R ❑ COS 117 HSC 25292.5 Failed to conduct ELD testing on a system located within 1 000'of a public well ❑ V ❑ R ❑ COS 118 HSC 25292.5 Failed to repair and retest system due to failed ELD test ❑ V ❑ R ❑ COS 119 CCR 2644.1(a)(5) Failed to submit ELD test results within 60 days ❑ V ❑ R ❑ COS 120 CCR 2663 Failed to inspect a lined or repaired steel tank within 10 years of lining and every 5 years after ❑ V ❑ R ❑ COS 121 CCR 2663 Failed to submit tank lining certification within 30 days or to conduct proper tests ❑ V ❑ R ❑ COS 122 HSC 25299 Documents were falsified or misrepresented ❑ V ❑ R ❑ COS 123 CCR 2661 Permit to repair UST system not obtained ❑ V ❑ R ❑ COS 124 CCR 2635(d) Failed to submit UST Certification of Installation/Modification ❑ V ❑ R ❑ COS Received by Inspector: Phone: Date: (initial): FATINAH ZAREEF, REHS (209) 953-7311 06/12/2015 Page 1 of 7