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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.sjgov.orcq/ehd <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Address: Date: <br /> CRUISERS MANTECA#29 1137 W LATHROP RD, MANTECA 14, 2016 <br /> Two violations were observed at the time of the permit inspection for SR0073494, and as such this inspection <br /> report was prepared to document these violations. <br /> Complete and submit a copy of the Return to Compliance Certification form to the EHD with a statement <br /> documenting the corrective actions that have been or will be taken for each violation, and any supporting <br /> paperwork, 30 days from receipt of this inspection report. <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 THI<_: <br /> FACILITY BACK INTO COMPLIANCE <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE <br /> Received by: Date: Inspector:p Inspector Phone: <br /> Printed Name and Title: ELENA MANZO, Senior REHS (209) 953-769'--- <br /> Page <br /> 53-%69'Page 4 of 4 <br />