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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.sigov.org/ehd <br /> Aboveground Petroleum Storage Act Inspection Report <br /> Facility Name: Facility Address: Date: <br /> FARMINGTON CIRCLE K 4469 S ESCALON BELLOTA BLVD February 16 2016 <br /> An inspection report was provided to the facility operator on the day of inspection. The report was amended by <br /> the EHD. The amended report replaces the initial report. <br /> Violation #716 was added. The site address was changed from 4391 S. Escalon Bellota Rd. <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, within 30 days of receiving the amended inspection report. <br /> Please be aware as of January 1, 2013, all businesses are required to submit all new(or any changes to existing) <br /> Aboveground Petroleum Storage Act (APSA) information online to the California Environmental Reporting System <br /> (CERS) at http://cers.calepa.ca.gov in addition to any other relevant activities and required fields. No later than <br /> January 1, 2014, all APSA data must be entered and or updated in CERS. <br /> Documents reviewed: SPCC Plan <br /> Documents provided: Return to Compliance Certification form, Schedule of free CUPA classes <br /> AFTER THE COMPLIANCE DATE, EHD WILL BILL FOR ALL TIME AND ACTIVITIES ASSOCIATED WITH BRINGING THIS <br /> FACILITY BACK INTO COMPLIANCE. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> Received by: Date: Inspector: Inspector Phone: <br /> /�l alPrinted Name and Title: <br /> l�G� STACY RIVERA, Senior REHS (209) 468-3440 <br /> Paae 8 of 8 <br />