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e <br /> • 0 RECEIVED <br /> OCT 21 2013 <br /> Tank and Secondary Containment ENVIRONMENTAL <br /> Assessment Document HEALTH DEPARTMENT <br /> This document was prepared for: <br /> Lodi Unified School District <br /> 820 S. Cluff Avenue <br /> Lodi, CA 95240 <br /> Tank/system identification: Used Oil Tank <br /> Date of inspections)/assessment: 10/4/13 i <br /> This report consists of six (6) pages. <br /> I certify under penalty of law that this document and all attachments were prepared under my <br /> direction or supervision in accordance with a system designed to assure that quali d personnel <br /> properly gather and evaluate the information submitted. Based on my inquiry of the person or <br /> persons who mange the system, or those persons directly responsible for gathering the <br /> information,the information submitted is, to be the best of my knowledge and belief,true, <br /> accurate, and complete. I am aware that there are significant penalties for submitting false 1 <br /> information,including the possibility of fine and imprisonment for knowing violations. <br /> Tom Mitchell <br /> California License #C52599 ofes <br /> Civil Engineer �oeR o y� �4p�oFEssro <br /> 14256 Doolittle Drive �o`�Ps Fyc y�oso. ti III+ <br /> San Leandro, CA 94577 C �? < - z <br /> 52 9 <br /> SrCHAN\£P�' <br /> � OFCA0- gTFOFCALI <br /> Date stamped/signed: 10/21/13 <br /> Lodi Unified School District Used Oil Tank Assessment <br />