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A NJ O A Q U l N Environmental Health Department <br /> COUNTY— <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Address: Date: <br /> COUNTRY MART GAS&FOOD 34243 S CHRISMAN RD, TRACY June 23, 2021 <br /> Other Violations <br /> 2010 See below Unlisted General violation ❑V ❑R ❑COS <br /> SUMMARY OF VIOLATIONS <br /> (CLASS I,CLASS II,or MINOR-Notice to Comply) <br /> Item# Remarks <br /> 102 CCR 2711 Failure to submit a complete and accurate application for a permit to operate a UST. <br /> OBSERVATION: The UST Facility Operating Permit Application contains an incorrect California Department of Tax <br /> and Fee Administration (CDTFA) Underground Storage Tank Account Number.The listed CDTFA(former BOE) <br /> number 044036263 was closed as of 10/30/2018. <br /> REGULATION GUIDANCE: The application for a permit to operate an underground storage tank shall include the <br /> CDTFA registration number issued to the owner of the tank, in accordance with HSC 25286. <br /> CORRECTIVE ACTION: This was updated on site in CERS to current CDTFA number 220562560. This was <br /> corrected on site. <br /> This is a minor violation. <br /> 107 HSC 25292.2; CCR 2711(a)(11)Failure to submit and maintain complete and current financial responsibility <br /> documents. <br /> OBSERVATION: Financial responsibility documents have not been submitted to the EHD. The most recent <br /> financial responsibility documents in CERS have expired and are dated: <br /> -6/3/2020 for Certificate of Financial Responsibility <br /> -6/3/2020 for Letter from Chief Financial Officer <br /> REGULATION GUIDANCE: Current financial responsibility documents are required to be submitted annually. <br /> CORRECTIVE ACTION: These documents were updated and uploaded into CERS on site today.This was <br /> corrected on site. <br /> This is a repeat violation, Class II. <br /> 109 CCR 2715(a)(1)(B), 2715(a)(3) Failure to submit"Designated Underground Storage Tank Operator Identification <br /> Form"within 30 days. <br /> OBSERVATION:A new designated operator,Amy Winkler, began conducting inspections on 5/20/2021 and <br /> notification was not provided to the EHD within 30 days of the change. <br /> REGULATION GUIDANCE: The owner or operator shall submit a"Designated Underground Storage Tank Operator <br /> Identification Form"no later than 30 days after any change in the designated UST operator(s). <br /> CORRECTIVE ACTION: This was updated and uploaded into CERS today.This was corrected on site. <br /> This is a minor violation. <br /> FA0003290 PR0231801 SCO01 06/23/2021 <br /> EHD 23-01 Rev.9/16/2020 Page 4 of 7 Underground Storage Tank Program OIR <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />