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lo" 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.sjgov.org/ehd <br />FacilityName: Facility Address: Date: <br />ty <br />COUNTRY CLUB FOOD & FUEL MINI MART* 1 1856 W COUNTRY CLUB BLVD, STOCKTON June <br />HSC 25298(c) Failed to comply with permanent closure requirements. <br />This UST system was found to be illegally abandoned. No person shall abandon an UST system without complying <br />with the requirements of HSC 25298. Immediately obtain a permit from the EHD to remove this UST system. A <br />"Failure to Obtain a Permit" penalty applies. <br />This is a Class I violation. <br />2030 Illegally abandoned UST system. This UST system was found to be illegally abandoned. No person shall abandon an <br />UST system without complying with the requirements of HSC 25298(a), (b), and (c). It is unknown what the plans are <br />for this facility. Immediately obtain a permit from the EHD to temporarily close or remove this UST system. A "Failure <br />to Obtain a Permit" penalty applies. <br />This is a Class I violation. <br />I Overall Inspection Comments: <br />On site for MSC & Routine, the UST system is abandoned. Immediately contact this office to discuss disposition of <br />the UST system at this address. <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 July 20, 2015 . <br />Please be aware that as of January 1, 2014, facility operators are required to upload the following UST program <br />documents into the California Environmental Reporting System (CERS): UST Monitoring Site Plan, UST <br />Certification of Financial Responsibility, UST Response Plan, UST Letter from Chief Financial Officer (if <br />applicable), and the Owner Statement of Designated Operator Compliance. The UST Owner/Operator: Written <br />Agreement, if applicable, can be stored at the facility or uploaded into CERS. <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE <br />Received By Received By (printed name and title): Date: <br />(signature): <br />Inspector Inspector (printed name and title): Inspector Phone: <br />(signature): FATINAH ZAREEF, REHS (209) 953-7311 <br />Page 7 of 7 <br />