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SAN rjOAQUIN Environmental Health Department <br /> -- C O U N i Y -- <br /> Underground <br /> --Underground Storage Tank Program Inspection Report <br /> Facility Name : Facility Address : FDa :COUNTRY CLUB MOBIL CIRCLE K T2575 COUNTRY CLUB BLVD , STOCKTON uary 18 , 2023 <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 /> Overall Inspection Comments : <br /> An inspection checklist was provided to the facility operator at the time of inspection . The inspector will provide <br /> a complete report to the facility operator within the next few weeks . <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 /> Note : Toe ywoMfI rl sl� stern c1ertVfI60►-i d0 s +I nab Is 1 Yomp [e +e <br /> dut &-tD aO 011 C f ese 1 Jrjrti u ann uCA r SYTIO rl <br /> �em()rs �10t � �-4-eWd 1t st r i S recu i red. -f-a b e <br /> do ►rl e 13 ) j 2e� 3 ar6 CA i-f� - hOLA Ir Yj o-fi-i Ce M uS + <br /> 1 � vi ed *4AjL AFI 101�j1 `tib S*tQfF *' iVV C GLSSoca C1W6 <br /> W� " +VL& m - I ns pec-t� Lf\ VvI-ed a�- '4u� <br /> c/ Av yy t- hwr lL6 r(A C <br /> AFTER THE COMPLIANCE DATE , EHD WILL BILL FOR ALL TIME AND ACTIVITIES ASSOCIATED WITH BRINGING <br /> THIS FACILITY BACK INTO COMPLIANCE . <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD' S CURRENT HOURLY RATE . <br /> Receive y : Date : q 1$ 1 ;13 Inspector: Inspector Phone : <br /> Printed Name and Title: SHEWIT WOLDEAREGAY, EH Specialist (209 ) 616-3063 <br /> w�v T�Y► '!�' FA0006439 PR0231070 SC001 01 /18/2023 <br /> EHD 23-01 Rev, 12/06/2021 Page 4 of 4 Underground Storage Tank Program OR <br /> 1868 E . Hazelton Avenue Stockton , California 95205 1 T 209 468 -3420 1 F 209 464 -0138 1 www . sjgov . org / EHD <br />