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Environmental Health Department Facility Name: Country Club Mobil Circle K Facility Address: 2575 COUNTRY CLUB BLVD, STOCKTON, CA 95204 Facility Phone: (209)932-1307 Program: 1920 -HMBP-Common Materials Inspection Type: ROUTINE INSPECTION -Operating Permit Date: July 25,2018 CERS ID: 10118074 Inspection Contact: Christine Prasad Consent For:Consent Given By: Rish Romana, Manager Title: Customer Service Phone: (209)932-1307 Inspection Photos Samples Hazardous Materials Program Inspection Report R =Repeat violation COS =Corrected on site during inspectionV=Violation CCR =California Code of Regulations HSC =Health and Safety Code CFR =Code of Federal Regulations Violations 1 □ V □ R □ COSFailed to pay annual operating feesSJO 4432 2 □ V □ R □ COSFailed to complete and electronically submit a hazardous materials business planHSC 25505, 25508(a) (1) 3 □ V □ R □ COSFailed to establish and implement a hazardous materials business planHSC 25507 4 ■ V □ R □ COSFailed to complete and/or submit the Business Activities or Owner/Operator Identification pageHSC 25508(a)(1) 5 □ V □ R □ COSFailed to complete and/or submit hazardous materials inventory for all reportable materials on siteHSC 25506(a)(1) 6 □ V □ R □ COSFailed to complete and/or submit a site map with all required contentHSC 25505(a)(2) 7 ■ V □ R □ COSFailed to establish and/or submit emergency response procedures for a release or threatened releaseHSC 25505(a)(3) 8 □ V □ R □ COSFailed to submit a training program or program is not reasonable or adequate for facilityHSC 25505(a)(4) 9 □ V □ R □ COSFailed to annually review and certify that the business plan is complete, accurate, and up to dateHSC 25508(a)(1) 10 □ V □ R □ COSFailed to submit revisions to business plan within 30 days of substantial change in operationsHSC 25508.1(a)-(f) 11 ■ V □ R □ COSFailed to provide or document initial and/or refresher training to appropriate personnelHSC 25505(a)(4) 12 □ V □ R □ COSFailed to have the business plan readily available to facility or EHD personnelHSC 25505(c) 13 □ V □ R □ COSFailed to notify property owner that facility is subject to and in compliance with the HMBP programHSC 25505.1 14 □ V □ R □ COSBusiness on leased property failed to provide copy of HMBP w/in 5 days of request by property ownerHSC 25505.1 15 □ V □ R □ COSFailed to report actual or threatened release to the EHD and/or CalOES Warning CenterHSC 25510(a) 16 □ V □ R □ COSFailed to submit emergency response plan when not meeting Ag handler exemption requirementsHSC 25507.1 17 □ V □ R □ COSFailed to submit training program when not meeting Ag handler exemption requirementsHSC 25507.1 18 □ V □ R □ COSFailed to establish and implement a HMBP when not meeting remote unstaffed facility exemptionsHSC 25505, 25507.2 19 □ V □ R □ COSFailed to submit a written response within 30 days of receiving an inspection reportHSC 25511 1010 □ V □ R □ COSUnlisted Administration/Documentation violation See below 1020 □ V □ R □ COSUnlisted Training violation See below 1030 □ V □ R □ COSUnlisted Operations/Maintenance violation See below 1040 □ V □ R □ COSUnlisted Release/Leaks/Spills violation See below 1045 □ V □ R □ COSUnlisted Release/Leaks/Spills - Local Ordinance See below 1050 □ V □ R □ COSUnlisted Abandonment/Illegal Disposal/Unauthorized Treatment violation See below 1055 □ V □ R □ COSUnlisted Abandonment/Illegal Disposal/Unauthorized Treatment - Local Ordinance See below Page 1 of 3 FA0006439 PR0519887 SC001 07/25/2018 EHD 19-01 Rev. 10/31/2017 Hazardous Materials Program OIR 1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com