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UHEVKUN LL1 b <br />LUU-� JI/9 p.1 <br />Agency Inspection Report Fax <br />(Please fax in ALL Agenc Inspection Reports with or without corrective actions) <br />DATE: —05/15/2014 1 Pages: 1 <br />(Including cover) <br />TO: Permit Desk <br />FAX (925) 842-9585 0 (925) 842-5660 <br />FR M: Station # 307709/ 218 Stockton CA <br />(Chevy n Facility #) I (CSI #) <br />Ph ne Number: 209-952-2 �13 <br />Pri t Manager Name: Ros Ila Biggs <br />My facility received the atoched (check appropriately below): <br />❑ OV - Notice of Violation: A C ocurnent issued by a Government or Local Agency identifying a <br />viola on or condition that requires a corrective action by a specified date and may require payment of a <br />monetary fine or penalty. <br />❑ TC - Notice to Comply: A do ument issued by a Government or Local Agency idendfving a <br />violation or condition of non-compliance that requires a corrective action by a specific date but does not levy a <br />monetaryfine or penalty. <br />® ther: 100% or Any Government or Local Agency document or communication (these include a <br />successfully passed inspection) <br />I have also notified my BC & RESH representative via phone and/or fax. <br />Narhe of BC: Diane Province <br />Nae of RESH Specialist: Gerardo Acuna <br />Notts: <br />In a q dition to faxing in the (legi le) inspection report, please place a copy of the notice <br />into he Retail Facility Complian a Workbook under Section 9 "RFC Inspections". <br />Updated 7-19.2011 <br />