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411 <br />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.sogov.org/ehd <br />CONTINUATION FORM <br />Page: 4 of 4 <br />OFFICIAL INSPECTION REPORT <br />Date: 01/15/13 <br />Facility Address: Country Club 76 Gas Station, 2575 Country Club Blvd <br />Program: UST <br />SUMMARY OF VIOLATIONS <br />CLASS I, CLASS II, or MINOR -Notice to Comply) <br />204. The designated operator failed to document all the alarms from the attached alarm history on the <br />2012 designated operator monthly inspection reports and failed to check that they were responded to <br />appropriately. The missing alarms include: <br />L1- 87 STP sump sensor - fuel alarm - 4-24-12 <br />1-22- Dispenser 7/8 annular sensor - fuel alarm - 4-24-12 <br />During the monthly inspection, the designated operator shall review the alarm history for the previous <br />month, check that each alarm was documented and responded to appropriately, and attach a copy of <br />the alarm history with documentation taken in response to any alarms to the monthly report. Ensure that <br />designated operators performing monthly inspections at this facility are including all of the required <br />information on the reports. <br />Notes <br />1. Complete the following by March 15, 2013 and send to the San Joaquin County Environmental <br />Health Department: <br />a. The Return to Compliance Certification form. <br />b. A statement explaining how each violation was corrected. <br />c. Supporting documentation. <br />ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RATE. <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />EHD Inspector: <br />Receive Title: <br />Garrett Backus (209) 468-2986 <br />EHD 23-02-003 Rev 04/19/12 CONTINUATION FORM <br />