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San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, California95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.smgov.orq/ehd <br />Underground Storage Tank Program Inspection Report <br />Facility Name: <br />Facility Address: <br />I 1 <br />Date: <br />FAST N ESY <br />1 11, 2015 <br />ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RATE. <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE <br />Received By <br />`may^ti <br />Received By (printed na a and title): <br />-- r <br />Date: <br />(signature): . - <br />y <br />Inspector <br />nspector ( rinted name and title): <br />Inspector Phone: <br />(signature): <br />=LE NA. MAN." QEH` <br />(�`� I Page 6 of 6 <br />