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Environmental Health DepartmentFacility Name:COUNTRY MART GAS & FOODFacility Address:34243 S CHRISMAN RD, TRACY, CA 95304Facility Phone:(209) 832-8642Program:2361 - UST FACILITYInspection Type:ROUTINE INSPECTION - Operating PermitDate:May 06, 2020CERS ID:10181085Inspection Contact:Taranjit Sandhu Consent For: Consent Given By:Taranjit Sandhu, OwnerTitle:OwnerPhone:(209) 914-5583InspectionPhotosSamplesUnderground Storage Tank Program Inspection ReportService Technician Manufacturer's Training:VR, 10/02/21; VMI, 12/18/20; OPW,03/17/22Service Technician Onsite:Zanne NimmoExp. Date:06/01/2021 Designated Operator: David WinklerExp. Date:02/17/2022HSC= Health and Safety CodeCFR= Code of Federal RegulationsCCR= Title 23 California Code of RegulationsR= Repeat violationCOS= Corrected on site during inspectionV= ViolationFile Review101□ V □ R □ COSFailed to obtain a permit to operate from the EHD including but not limited to unpaid permit feesHSC 25284; CCR 2711(d)102□ V □ R □ COSNo written agreement between tank owner and tank operator to monitor the tank systemHSC 25284(a)(3)(A)/(B)103□ V □ R □ COSFailure to submit and maintain complete and current financial responsibility documentsHSC 25292.2, 25299.30104□ V □ R □ COSUST operating permit application for facility and tank information not submitted or currentCCR 2711105□ V □ R □ COSFailed to have an approved UST monitoring planCCR 2632(d)(1), 2634(d)106□ V □ R □ COSFailed to have an approved UST response planCCR 2632(d)(2), 2634(e)107□ V □ R □ COSPlot plan/site map not submitted or failed to completely show where monitoring is performedCCR 2632(d), 2641(h), 2711(a)108□ V □ R □ COSFailed to notify the EHD 48 hours prior to conducting testingCCR 2637, 2638(e), 2643(g)109□ V □ R □ COSFailed to test secondary containment, or failed to maintain test records for 36 monthsCCR 2637(a-d), 2712110□ V □ R □ COSFailed to submit "Secondary Containment Testing Report Form" within 30 days after the testCCR 2637(e), 2637(f)111□ V □ R □ COSFailed to test monitoring and leak detection equipment every 12 monthsCCR 2638, 2641(j), 2715(f)112□ V □ R □ COSFailure to maintain UST records to enable the UPA to determine whether the UST is in complianceHSC 25293113□ V □ R □ COSFailure to submit "Monitoring System Certification Form" within 30 days of completion of the testCCR 2638(c), 2638(d)114□ V □ R □ COSNo 0.1 gph annual line integrity test for pressurized piping, or within 30 days after repairCCR 2636(f)(3), 2643(c)(3)115□ V □ R □ COS"Designated Underground Storage Tank Operator Identification Form" not submitted within 30 daysCCR 2715(a)(1)(B), 2715(a)(3)116□ V □ R □ COSDesignated operator, service tech or installer did not possess current ICC certificationCCR 2715117□ V □ R □ COSFailure to comply with tank lining, recordkeeping, and inspection requirementsCCR 2663, 2712(b)(6)118□ V □ R □ COSFailure to submit the "Underground Storage Tank Statement of Understanding and Compliance Form"CCR 2715(a)(1)(A), 2715(a)(2)119□ V □ R □ COSDocuments were falsified or misrepresentedHSC 25299(a)(8), 25299(b)(7)120□ V □ R □ COSFailed to submit UST Certification of Installation/ModificationCCR 2635(d)121□ V □ R □ COSFailure to implement corrections and submit written response within 30 days of receiving the reportCCR 2712(f)122□ V □ R □ COSFailure to submit and/or maintain documentation regarding compatibility for UST system componentsCCR 2631, 2640.1, 2665, 2711FA0003290 PR0231801 SC001 05/06/2020EHD 23-01 Rev. 9/20/2019Underground Storage Tank Program OIRPage 1 of 51868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com