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San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California95205-6232 <br /> Telephone., (209) 468-3420 Fax.(209) 468-3433 Web.wwW.siaov.orD/ehd <br /> Hazardous Materials Program Inspection Report <br /> Facility Name: Facility Address: Date: <br /> QUIK STOP MARKET#2121 1 1196 W LOUISE AVE, MANTEL July 29 2015 <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 8HD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY 8YTHE 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 /> Received By Received By(printed name and title): Date: I <br /> (signature): kA,, . f bet K p Kaur, Shift lead d1 gq Is <br /> Inspector Inspector(printed name and title): Inspector Phone: <br /> (signature): !OLAS LOEHRER, HM Specialist 1 (209) 468-0623 <br /> Page 2 of 2 <br />