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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.sjaov.org/ehd <br /> Hazardous Materials Program Inspection Report <br /> Facility Name: Facility Address: Date: <br /> LAKEWOOD CHEVRON 236 N HAM LN LODI December 01, 2015 <br /> Complete and submit a copy of the Return to Compliance Certification form to the EHD with a statement <br /> documenting the corrective actions that have been or will be taken for each violation, and any supporting <br /> paperwork, by 12/31/2015 <br /> Please be aware as of January 1, 2013, all businesses are required to submit all hazardous materials information <br /> online to the California Environmental Reporting System (CERS) at http://cers.calepa.ca.gov. Be sure to include <br /> your hazardous material activity in the Businesses Activities section in CERS in addition to any other relevant <br /> activities and required fields. <br /> ALL EHD STAFF TIME ASS CIATED WITH FAILING TO COMPLY BV THE ABOVE NOTED DATES WILL BE a LLED AT THE CURRENT HOURLY RATE. <br /> THIS FACE TY IS SUBJE T TO REINSPECTION AT ANYTIME AT EHD'S CURRENT HOURLY RATE. <br /> Received Received By(printed name and title): Date: <br /> (signature): Cathy Huber, Cashier <br /> Inspector Inspector(printed name and title): Inspector Phone: <br /> (signature): JAMIE DE LA ROSA, HM Specialist II 209) 953-6211 <br /> Page 2 of 2 <br />