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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, California 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sggov.org/ehd/unitiii.html <br /> CONTINUATION FORM Page: 3 of 3 <br /> OFFICIAL INSPECTION REPORT Date: 08/11/1 " <br /> Facility Address: 155.3 colony Road, Ripon Program: UST <br /> SUMMARY OF VIOLATIONS <br /> CLASS I,CLASS II,or MINOR-Notice to Comply) <br /> UST inspection Report <br /> 3. UST tank forms on file with the EHD are not complete and current. Any change of information on <br /> these forms must be submitted to the EHD within 30 days of the changes. Immediately complete and <br /> submit a copy of the facility and tank forms to the EHD. Complete a separate tank form for each tank. A <br /> updated copy was provided on site. <br /> 4. Financial responsibility documents have not been submitted to the EHD. The last financial <br /> responsibility document was submitted on 3/31/10. Current financial responsibility documents are <br /> required to be submitted annually. A current financial responsibility document was provided on site. <br /> Notes <br /> Provided free UST class information. <br /> ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RATE($122). <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD Inspector: Received By: Title: (DG15� <br /> EHD 23-02-003 Rev 08/10/10 CONTINUATION FORM <br />