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San Joaquin County 180 <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sigov.oro/ehd <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Address: Date: <br /> RALEYS FUEL STATION M56 4219 E MORADA LN, STOCKTON July 20, 2017 <br /> Please be aware that as of January 1, 2014, facility operators are required to upload the following UST program <br /> documents into the California Environmental Reporting System(CERS): UST Monitoring Site Plan, UST <br /> Certification of Financial Responsibility, UST Response Plan, UST Letter from Chief Financial Officer(if <br /> applicable), and the Owner Statement of Designated Operator Compliance. The UST Owner/Operator: Written <br /> Agreement, if applicable, can be stored at the facility or uploaded into CERS. <br /> AFTER THE COMPLIANCE DATE, EHD WILL BILL FOR ALL TIME AND ACTIVITIES ASSOCIATED WITH BRINGING <br /> THIS FACILITY BACK INTO COMPLIANCE. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE <br /> Received by: Date: July 20, 2017 Inspector: r(2 <br /> or Phone: <br /> Printed Name and Title: VICKI MCCARTNEY, Senior REHS 468-9852 <br /> Dawn Dircksen, Manager <br /> FA0016523 PR0524617 SC001 07/20/2017 <br /> EHD 23-01 Rev.09/22/16 Page 4 of 4 Underground Storage Tank Program OR <br />