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i i i I Environmental ' Health Department � AN < � I G ye I Facility Name:. Facility Phone: Date: COUNTRYSIDE LIQUORS & GAS (209) 368-5380 March 30, 2020 Facility Address: CERS to: 14971 N HWY 88 , LODI , CA 95240 10180623 Inspection Contact Title: Phone: Bikram Sodhi Manager (209) 931 -3674 Inspection Type: r236, ogram: ROUTINE INSPECTION - Operating Permit - UST FACILITY Consent For: Consent Given By: I@ Inspection I@Photos ❑ Samples Bikram Sodhi, Manager Service Technician Onsite: Exp. Date: Designated Operator: Exp. Date: David Winkler 01 /22/2022 Alex Jabbari 10/01 /2020 Service 'Technician Manufacturees Training: VR, 02/09/22; VMI , 11 /07/21 ; SB, 11 /29/20 CCR Title 23 Calrome Code of Regulations HSC = Health and Safety Code CFR = Code of Federal Reguialions V = Violation R = Repeat violation COS = Corrected on site during Inspection t $11 �It ' . ...� lot HSC 25284; CCR Failed to obtain a permit to operate from the EHD including but not limited to unpaid permit fees o V o R ❑ COS 2711 (d) 102 HSC 25284(a)(3)(A)/(B) No written agreement between tank owner and tank operator to monitor the tank system o V o R o COS 103 HSC 25292.21 25299.30 Failure to submit and maintain complete and current financial responsibility documents o V o R o COS 104 CCR 2711 UST operating permit application for facility and tank information not submitted or current o V o R o COS 105 CCR 2832(d)(1 ), Failed to have an approved UST monitoring plan o V o R ❑ COS 2634(d) j 106 CCR 2632(d)(2), Failed to have an approved UST response plan o V o R o COS 2634(e) 107 CCR 2632(d), 2641 (1 Plot plan/site map not submitted or failed to completely show where monitoring is performed o V o R o COS 2711 (a) j 108 CCR 2637, 26311 Failed to notify the EHD 48 hours prior to conducting testing o V o R o COS 2643(g) 109 CCR 2637(a-d), 2712 Failed to test secondary containment, or failed to maintain test records for 36 months o V o R o COS 110 CCR 2637(e), 2637(1) Failed to submit "Secondary Containment Testing Report Form" within 30 days after the test o V o R o COS 111 CCR 2638, 26410), Failed to test monitoring and leak detection equipment every 12 months o V o R o COS 2715(f) 112 HSC 25293 Failure to maintain UST records to enable the UPA to determine whether the UST is in compliance o V o R o COS f 113 CCR 2638(c), 2638(d) Failure to submit "Monitoring System Certification Form" within 30 days of completion of the test ❑ V o R ❑ COS 114 CCR 2636(1)(3), 2643(c) No 0. 1 gph annual fine integrity test for pressurized piping, or within 30 days after repair o V o R o COS (3) 115 CCR 2715(a)(1)(B), "Designated Underground Storage Tank Operator Identification Form" not submitted within 30 days ❑ V ❑ R 13 COS 2715(a)(3) 116 CCR 2715 Designated operator, service tech or installer did not possess current ICC certification o V o R o COS 117 CCR 2663, 2712(b)(6) Failure to comply with tank lining, recordkeeping, and inspection requirements o V o R o COS 118 CCR 2715(a)(1)(A), Failure to submit the "Underground Storage Tank Statement of Understanding and Compliance Form" ❑ V ❑ R o COS 2715(a)(2) 119 HSC 25299(a)(8), Documents were falsified or misrepresented o V o R o COS 25299(b)(7) 120 CCR 2635(d) Failed to submit UST Certification of InstallationlModification o V o R o COS 121 CCR 2712(f) Failure to implement corrections and submit written response within 30 days of receiving the report ❑ V ❑ R o COS � 122 CCR 2631 , 2640.1 , Failure to submit and/or maintain documentation regarding compatibility for UST system components ❑ V ❑ R ❑ COS I 2665, 2711 i FA0000540 PR0231911 SCOOt 03/30/2020 EHD 23-01 Rev, 9/2012018 Page 1 of 6 Underground Storage Tank Program OIR 1868 E. Hazelton Avenue Stockton , California 95205 T 209 468-3420 F 209 464-0138 1 www.sjcehd . com i i