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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.sjaov.orcI/ehd <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Address: Date: <br /> COUNTRY CLUB MOBIL CIRCLE K 2575 COUNTRY CLUB BLVD STOCKTON January 29 2019 <br /> Other Violations <br /> 2010 1 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 /> Overall Inspection Comments: <br /> An inspection checklist was provided to the facility operator at the time of inspection. The EHD will generate and <br /> provide a complete report to the facility operator. <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, within 30 days of receiving the complete inspection report. <br /> AFTER THE COMPLIANCE DATE, EHD WILL BILL FOR ALL TIME AND ACTIVITIES ASSOCIATED WITH BRINGING THIS <br /> FACILITY BACK INTO COMPLIANCE. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> Received by: Date: January 29, 2019 Inspector: Inspector Phone: <br /> J Printed Name and Title: STACY RIVERA, Senior REHS (209)468-3440 <br /> Taranjit Romana, manager <br /> FA0006439 PR0231070 SCO01 01/29/2019 <br /> EHD 23-01 Rev.09/22/16 Page 4 of 4 Underground Storage Tank Program OIR <br />