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02/07/2013 13:51 209-59900 CEI1714 0 PAGE 01/04 <br />Agency inspection Report Fax <br />(Please fax in ALL Agency inspection Reports with or without corrective actions) <br />DATE: _217/2013 Pages: 4 <br />(Including cover) <br />TO: Permit Desk <br />FAX (925) 842-9585 or (925) 842-5660 <br />FROM: Station # 21099711714 Ripon CA <br />(Chevron Facility #) / (CSI #) <br />Phone Number: 209-599-0149 <br />Print Manager Name: Patty Aguayo <br />My facility received the attached (check appropriately below): <br />❑ NOV - Notice of Violation: A document issued by a Government or Local Agency identifying a <br />violation or condition that requires a corrective action by a specified date and may require payment of a <br />monetary fine or penalty. <br />Z NTC - Notice to Comply: A document issued by a Government or Local ,Agency identifying a <br />violation or condition of non-compliance that requires a corrective action by a specific date but does not levy a <br />monetary f me or penalty. <br />❑ Other: 100% or Any Government or Local Agency document or commwiication (these include a <br />successfully passed inspection) <br />I have also notified my BC & RESH representative via phone and/or fax. <br />Name of BC: Diane Province <br />Name of RESH Specialist: Gerardo Acuna <br />Notes: <br />In addition to faxing in the (legible) inspection report, please place a copy of the notice <br />into the Retail Facility Compliance Workbook under Section 9 "RFC Inspections". <br />Updated 7-19-2011 <br />