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San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone: (209) 468-3424 Fax: (209) 468-3433 Web:www.sjgov.orcI/ehd <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Address: Date: <br /> SPOR <br /> Please be aware that as of January 1. 2014 facility operators are required to upload the following UST pror,,,--,m <br /> documents into the California Environmental Reporting System(CERS)- UST Monitoring Site Plan, UST <br /> Certification of Financial Responsibility, UST Response Flan, UST Letter from Chief Financial Officer(if <br /> applicable). and the Owner Statement of Designated Operator Compliance The UST Owner/Operator: Writt ,. <br /> Agreement, if applicable, can be stored at the facility or uploaded into CERS. <br /> NOTE- An electrical splice, located outside the J-box, was noted on the annular sensor cable. The interstitial <br /> space shall be monitored with a monitoring system connected to an audibie and visual alarm system. Contact the <br /> local fire department to determine if a sensor repair/replacement is needed to remedy this installation issue. If a <br /> sensor replacement or repair is necessary. contact a properly licensed, trained. and certified contractor to replace <br /> the noted component with a functional component(LG 113-x listed, if applicable) under permit and inspection of <br /> =HD. <br /> ALL EHD STAFF TIME ASSOCIATED WITH FAILING,TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RATE <br /> T ACILI IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE <br /> Received �yReceived By(printed name and title): bat : <br /> (signature): C 1, 1-eL:J ALF ! c <br /> Inspector Inspector(printed name and title): Inspector Phone: <br /> (signature): (2U-t11 yZ)i-t I') <br /> Page 5 of 5 <br />