Laserfiche WebLink
02/02/2012 14:50 209-59901 GSI1714 PAGE 01/06 <br />Agency Inspection Report IFax <br />(Please fax In ALL, Agency Inspection Reports with or without corrective actions) <br />DATE: JEB. 252012 <br />Pages: 5 <br />(Including cover) <br />TO: Permit Desk <br />FAX (925) 842-9585 or (925) 842-5660 <br />FROM: Station # 21099711714 Ripon DA <br />(Chevron Facility #) I (CSI #) <br />Phone Dumber: 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 Govermnent or Local Agency identifying a <br />violation ox condition that requires a corrective action by a specified date and may require payment of a <br />monetary fine or penalty. <br />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 fmc or penalty. <br />[] Other: 10 % or Any Govenunent or Local Agency document or communication (these include a <br />successfully passed inspection) <br />I have also notified my BC & RESH representative via phone and/or fax. <br />Name of BD: Divine 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 749-2011 <br />