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i Environmental Health Department S 0 > U , - (AU I< Y - � ry _ Facility Name: Facility Address: Date: j COUNTRYSIDE LIQUORS & GAS 14971 N HWY 88 , LODi IlMarch30, 2020 9 � _ _� s _ 1�i MORIw _ 1 123 L CCR 2637.1 (d), Failure to submit the "Spill Container Testing Report Form" within 30 days after the test ■ V ❑ R ❑ COS 2637.1 (e) 124 CCR 2637.2(d&e), "Overfill Prevention Equipment Inspection Report Form" not submitted within 30 days of inspection ❑ V ❑ R ❑ COS 2665(a&b) WWII _ If Mom F CCR 2712(b)(1-2) Failure to maintain monitoring, maintenance, and follow up action records ❑ V ❑ R ❑ COS CCR 2715(c)(3), Failure to maintain the "Facility Employee Training Certificate" on-site (after October 1 , 2018) ❑ V ❑ R ❑ COS 2715(c)(4) 203 CCR 2712(b)(6) Failure to maintain records of repairs, lining, and upgrades on site, for the life of the UST ❑ V ❑ R ❑ COS i 204 CCR 2712(i) Current monitoring plan approved by the EHD not found on site ❑ V ❑ R ❑ COS F207 CCR 2712(1), 2634(e) Failure to submit a current UST Response Plan and have it available onsite o V ❑ R ❑ COS j CCR 2712 Failure to comply with UST operating permit conditions ❑ V ❑ R ❑ COS HSC 25294 Failed to record unauthorized release from primary containment ❑ V ❑ R ❑ COS CCR 2650(e), 2652 Failed to notify the EHD of a reportable unauthorized release and/or prepare a report ❑ V ❑ R ❑ COS 209 CCR 2716(a-e) Failure to conduct the designated UST operator visual inspection at least once every 30 days ■ V ■ R ❑ COS 210 CCR 2716(0 DO monthly reports not maintained on site for 12 months or for 36 months (after October 1 , 2018) ❑ V ❑ R ❑ COS 211 CCR 2715(c)(2) No employee present that were trained in the operation and maintenance of the UST system by a DO 13 V ❑ R ❑ COS i212 CCR 2715(c)(2) Unstaffed facility failed to have or implement a training program approved by the UPA ❑ V ❑ R ❑ COS 213 HSC 25281 .5(b)(2) Unburied fuel piping at marinas not visually inspected at least daily or log not kept ❑ V ❑ R ❑ COS 214 HSC 25281 .5(b)(3) Unburied emergency generator fuel piping not visually inspected at least monthly or log kept o V ❑ R ❑ COS 215 CCR 2712(i) Failure to retain a copy of the permit to operate at the facility ❑ V ❑ R ❑ COS If - I 301 HSC 25292.1 (a) UST system is not operated to prevent unauthorized release, including spills and overfills ❑ V o R o COS 302 NSC 25291 (b) UST system incapable of detecting leak from primary into secondary containment (pre-Jul 2003) ❑ V ❑ R ❑ COS 303 HSC 25290.2(d) Monitoring system not maintained to detect entry into secondary containment (Jul 2003-Jun 2004) ❑ V ❑ R ❑ COS 304 HSC 25290.1 (d) Monitoring system not maintained to detect entry into secondary containmeit (after Jul 2004) ❑ V ❑ R ❑ COS 305 HSC 25290.1 (e) VPN monitoring of the interstitial spaces of the UST system is not maintained ❑ V ❑ R ❑ COS 306 CCR 2630(d), 2641 (a) Monitoring equipment is not installed or maintained to detect a leak at the earliest opportunity ❑ V ❑ R ❑ COS 307 CCR 2631 (8), 2632(c) Monitoring system of the interstitial space of a double wailed system not maintained ❑ V ❑ R ❑ COS 308 CCR 2632(c), 2634(d), Failed to maintain a continuous monitoring system that activates an audible and visual alarm ❑ V ❑ R ❑ COS 2636(f) 309 CCR 2636(f)(1 ) Monitoring in sump / UDC failed to activate an audible and visual alarm or stop the flow product ❑ V ❑ R ❑ COS 310 CCR 2636(f)(4) Piping is not tali-safe outside UDCs or fails to stop now of product at dispenser inside UDCs ❑ V ❑ R ❑ COS 311 CCR 2638(a), 26410) Failed to properly program, calibrate, operate, or maintain leak detection equipment ❑ V ❑ R o COS 312 CCR 2638(f), 2641 (1) Failed to affix a tag sticker on monitoring equipment certified, repaired, or replaced ❑ V ❑ R ❑ COS 313 HSC 25290. 11 25290.2, Failure to construct, operate, and maintain primary containment as product tight ❑ V oR ❑ COS I 25291 i � FA0000540 PR0231911 SC001 03130/2020 jUnderground Storage Tank Program OIR EHD 23-01 Rev. 9/2012019 Page 2 of 6 I 1868 E . Hazelton Avenue Stockton , Califomia 95205 1 T 209 468-3420 F 209 464-0138 ( www.sjcehd .com i l