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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sugov.org/ehd <br />CONTINUATION FORM <br />Page: 4 of 4 <br />OFFICIAL INSPECTION REPORT <br />Date: 06/12/14 <br />Facility Address: 1399 E Yosemite Ave., Manteca <br />Program: UST <br />SUMMARY OF VIOLATIONS <br />CLASS I, CLASS II, or MINOR -Notice to Comply) <br />Note: Facility operators are required to upload the following UST program documents into the <br />California Environmental Reporting System (CERS): UST Monitoring Site Plan, UST Certification of <br />Financial Responsibility, UST Response Plan, UST Owner/Operator: Written Agreement (if applicable), <br />UST Letter from Chief Financial Officer, and Owner Statement of Designated UST Operator <br />Compliance. After January 1, 2015, noncompliance with this requirement will be a violation. <br />Complete and submit a copy of the Return to Compliance Certification form with a statement of how <br />each violation was corrected, including supporting documentation, by July 6, 2014. <br />Provided: <br />-Return to Compliance Certification form <br />-Schedule of Free Classes <br />Discussed: <br />-CERS requirements and the necessity for the EHD office appointment scheduling <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 JT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />EHD Inwe <br />Q a V? , <br />Received y: <br />Title: <br />EHD 23-02-003 Rev 04/19/12 1 / �— CONTINUATION FORM <br />