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S A N J 0 A Q I I I Irl Environmental Health Department <br /> CCUNr <br /> Hazardous Materials Program Inspection Report <br /> Facility Name: Facility Address: Date: <br /> COSTCO WHOLESALE#172 25501 S GATEWAY BLVD, TRACY July 28, 2021 <br /> SUMMARY OF VIOLATIONS <br /> (CLASS I,CLASS II,or MINOR-Notice to Comply) <br /> Item# Remarks <br /> 12 HSC 25505(c) Failed to have the HMBP readily available to facility or EHD personnel. <br /> OBSERVATION: Facility could not provide the Emergency Response Plan and the inventory information upon <br /> request. <br /> REGULATION GUIDANCE: The emergency response plans and procedures,the inventory of information required <br /> by this article, and the site map required by this section shall be readily available to personnel of the business or the <br /> unified program facility with responsibilities for emergency response or training pursuant to this section. <br /> CORRECTIVE ACTION: Immediately make arrangements to have the business plan readily available for review. <br /> This is a Class II violation. <br /> 15 HSC 25510(a)Failed to report actual or threatened release to the EHD and/or CalOES Warning Center. <br /> OBSERVATION:A release of anhydrous ammonia occurred on 5/26/2021 and was not reported to the EHD and <br /> CalOES. Per the incident investigation report, Loose Strainer Cap-EV 42 caused the release of less than 1 pound <br /> of anhydrous ammonia into the atmosphere. The released caused 199 employees to be evacuated from the area. <br /> REGULATION GUIDANCE:A release or threatened release of a hazardous material shall be verbally reported <br /> immediately to the EHD and CalOES. <br /> CORRECTIVE ACTION: Submit a written statement to EHD stating any future releases or threatened releases of a <br /> hazardous material will be reported immediately to the EHD and CalOES. <br /> This is a Class I violation. <br /> Overall Inspection Comments: <br /> Conducted a Hazardous Materials Business Plan (HMBP) inspection. There were 4 violation(s) during the <br /> inspection. Complete and submit a copy of the Return to Compliance Certification form to the EHD with a <br /> statement documenting the corrective actions that have been or will be taken for each violation, and any <br /> supporting paperwork, by August 27, 2021. <br /> To minimize person to person contact EHD is choosing to write the name of person receiving the report instead <br /> of having them sign. Starting September 1, 2018, all in-office CERS help will be provided at EHD hourly rate <br /> ($152). To schedule an appointment, please call (209)468-3420. <br /> The report was emailed to Jimmee Kim, staff manager, at<d172adm@costco.com>. <br /> Note: The facility removed the propane tank. <br /> FA0011171 PR0520719 SCO01 07/28/2021 <br /> EHD 19-01 Rev.9/16/2020 Page 3 of 4 Hazardous Materials 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 />