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• RECEIVED <br /> OCT 15 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 Antifreeze Tank <br /> Date of inspection(s)/assessment: 10/4/13 <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 qualified 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 <br /> information, including the possibility of fine and imprisonment for knowing violations. <br /> Tom Mitchell <br /> California License *M26178 OOFESs/o , <br /> Mechanical Engineer IZ-1 s o'�c F� <br /> 14256 Doolittle Drive -6D F <br /> San Leandro, CA 94577 " m <br /> E yS <br /> �rFCF'CAtFq�� <br /> Date stamped/signed: 10/4/13 <br /> Lodi Unified School District Used Antifreeze Tank Assessment <br />