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April 13, 2004 <br />Countryside Mini Mart <br />Attn: Gary Burgin <br />14971 N. Hwy 88 <br />Lodi CA 95240 <br />RE: Countryside Mini Mart <br />San Joaquin County Environmental Health Department (EHD) performed a routine underground storage tank <br />inspection on October 13, 2003 the above referenced site. <br />An inspection report was issued to you along with a request for pertinent information that was necessary in order to <br />bring this site into compliance. You were required to submit this information by November 13, 2003. <br />Failure to correct the violations will result in continuing/additional violations. Failure to submit the completed <br />underground storage tank information by May 13, 2004 may result in further legal action. <br />The missing information include(s); <br />Current State Form A <br />❑ Current State Form B <br />pw-1 Monitoring and Response Plan <br />C Annual Line Tightness Test Results <br />Submit Certification of financial responsibility <br />❑ and letter from the chief financial officer <br />Annual Line Leak Detector Results <br />❑ Annual Monitoring Certification <br />Maintenance and Monitoring Log <br />❑ Permit submitted to repair/replace failed equipment <br />r Submit secondary containment test results <br />Most forms may be accessed from our web site address, ",w.geocities.com/unitii. <br />If you have any questions, please call Dennis Catanyag, Senior R.E.H.S at 209.468.3459. <br />Sincerely, <br />Dennis Cat ag, em r REHS <br />Registered Environmental Health Specialist <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />SAN JOAQUIN COUNTY <br />Supervisors <br />a.a <br />y <br />Donna K. Reran, R.E.H.S. <br />Director <br />304 East Weber Avenue, Third Floor <br />Unit <br />Carl Borgman, R.E.H.S. <br />Mike Huggins, R.E.H.$„ R.D.I. <br />. •, :'• <br />Al Olsen, R.E.H.S. <br />Stockton, California 95202-2708 <br />Douglas W. Wilson, R.E.H.S. <br />Program Manager <br />Telephone: (209) 468-3420 <br />Margaret Lagorio, R.E.H <br />/FOR <br />Laurie A. Cotulla, R.E.H.S. <br />Fax: (2Q9) 464-0138 <br />Robert McClellon, R.E.IS. <br />Program Manager <br />MarkBarcellos, R.E.H.S. <br />April 13, 2004 <br />Countryside Mini Mart <br />Attn: Gary Burgin <br />14971 N. Hwy 88 <br />Lodi CA 95240 <br />RE: Countryside Mini Mart <br />San Joaquin County Environmental Health Department (EHD) performed a routine underground storage tank <br />inspection on October 13, 2003 the above referenced site. <br />An inspection report was issued to you along with a request for pertinent information that was necessary in order to <br />bring this site into compliance. You were required to submit this information by November 13, 2003. <br />Failure to correct the violations will result in continuing/additional violations. Failure to submit the completed <br />underground storage tank information by May 13, 2004 may result in further legal action. <br />The missing information include(s); <br />Current State Form A <br />❑ Current State Form B <br />pw-1 Monitoring and Response Plan <br />C Annual Line Tightness Test Results <br />Submit Certification of financial responsibility <br />❑ and letter from the chief financial officer <br />Annual Line Leak Detector Results <br />❑ Annual Monitoring Certification <br />Maintenance and Monitoring Log <br />❑ Permit submitted to repair/replace failed equipment <br />r Submit secondary containment test results <br />Most forms may be accessed from our web site address, ",w.geocities.com/unitii. <br />If you have any questions, please call Dennis Catanyag, Senior R.E.H.S at 209.468.3459. <br />Sincerely, <br />Dennis Cat ag, em r REHS <br />Registered Environmental Health Specialist <br />