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SAN-,,JOAQUIN Environmental Health Department COUNTY C7, Greatness grows here, Underground Storage Tank Program Inspection Report Facility Name: Facility Phone: Date: COUNTRY CLUB MOBIL CIRCLE K (209)932-1307 January 18, 2023 Facility Address: CERS ID: 2575 COUNTRY CLUB BLVD, STOCKTON, CA 95204 10118074 Inspection Contact: Title: Phone: Sartaj Singh Owner (207)838-5400 Inspection Type: Program: ROUTINE INSPECTION-Operating Permit 12351 - UST FACILITY-2481 COMPLIANT Consent For: Consent Given By: ❑x Inspection ❑x Photos ❑x Samples Dominete Rillamas, Manager Service Technician Onsite: Exp.Date: Designated Operator: Exp.Date: Edward Stearns 11/05/2024 David Winkler 02/17/2024 Service Technician Manufacturer's Training: VR, 07/31/23;VMI, 05/27/23; FF, 11/26/24 CCR=Title 23 California Code of Regulations HSC=Health and Safety Code CFR=Code of Federal Regulations EHD=Environmental Health Department V=Violation R=Repeat violation COS=Corrected on site during inspection File Review 1017271 HSC 25284;CCR Failure to obtain a permit to operate from the EHD including but not limited to unpaid permit fees ■V ■R ❑COS 1(d) 102 CCR 2711 Failure to submit a complete and accurate application for a permit to operate a UST ❑V ❑R ❑COS 103 CCR 2635(f),2636(c)(2) Failure to submit the UST Certification of Installation/Modification ❑V ❑R ❑COS 104 CCR 2632(d)(1), Failure to submit a complete and accurate UST Monitoring Plan ❑V ❑R ❑COS 2634(d) 105 CCR 2632(d)(2), Failure to submit a complete and accurate UST Response Plan ❑V ❑R ❑COS 2634(e) 106 CCR 2632(d),2641(h) Failure to submit and maintain a current facility plot plan/site map ❑V ❑R ❑COS 107 HSC 25292.2;CCR Failure to submit and maintain complete and current financial responsibility documents ■V ■R ❑COS 2711(a)(11) 108 CCR 2620(b);HSC Failure to implement or maintain a written agreement between the UST owner and operator ❑V ❑R ❑COS 25284(a)(3) 109 CCR 2715(a)(1)(B), Failure to submit"Designated Underground Storage Tank Operator Identification Form"within 30 days ■V ❑R ❑COS 2715(a)(3) 110 CCR 2715(a)(1)(A), Failure to submit the"Underground Storage Tank Statement of Understanding and Compliance Form" ❑V ❑R ❑COS 2715(a)(2) 111 CCR 2637,2638(e), Failed to notify the EHD 48 hours prior to conducting testing ❑V ❑R ❑COS 2643(8) 112 CCR 2638,26410), Failure to have properly qualified service technician test leak detection equipment every 12 months ■V ■R ❑COS 2715(f) 113 CCR 2637(a-d),2712(b) Failure to conduct secondary containment testing ❑V ❑R ❑COS (1)(F) 114 CCR 2636(f)(3),2643(c) Failure to perform line integrity test every 12 months or within 30 days of repair of primary pipe ❑V ❑R ❑COS (3) 115 CCR 2638(c),2638(d) Failure to submit"Monitoring System Certification Form"within 30 days of completion of the test ■V ■R ❑COS 116 CCR 2637.1(d), Failure to submit the"Spill Container Testing Report Form"within 30 days ■V ■R ❑COS 2637.1(e) 117 CCR 2637(e),2637(f) Failed to submit"Secondary Containment Testing Report Form"within 30 days after the test ❑V ❑R ❑COS 118 CCR 2637.2(d&e), Failure to submit the"Overfill Prevention Equipment Inspection Report Form"within 30 days ❑V ❑R ❑COS 2665(a&b) 119 CCR 2663, 2712(b)(6) Failure to comply with tank lining certification,testing,inspection,and record requirements ❑V ❑R ❑COS 120 CCR 2631,2640.1, Failure to submit and/or maintain documentation regarding compatibility for UST system components ❑V ❑R ❑COS 2665,2711 FA0006439 PR0231070 SCO01 01/18/2023 FHD 23-01 Rev.12/06/2021 Page 1 of 10 Underground Storage Tank Program OIR 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD