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RECEIVED JAN 14 2019 <br /> Agency Inspection Report Fax <br /> ( Please fax In ALL Agency Inspection Reports with or without corrective actions) <br /> DATE , L Pages . <br /> _ Pages . <br /> (including cover) <br /> TO : Permit Desk <br /> FAX (925 ) 842 -9585 or ( 925 ) 842 =5650 <br /> FROM * Station # �b 1 �`� 1 k) <br /> ( Chevron �a I ty #) I ( CSI #) <br /> Phone Number : ` ` l 1 <br /> Print Manager Name : _._. <br /> My facility received the attached ( check appropriately below) : <br /> `i ,,NOV - Notice of Violation, A document issued by a Government or Local Agency identifying a <br /> violation or condition that requires a corrective action by a specified date and may require payment of a <br /> monetary fine or penalty . <br /> FITC - Notice to Comply ; A document issued by a Govmunent 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 fine or ponalty, <br /> Other: 100 % or Any Government or Local Agency document or communication (these include a <br /> successfully passed inspection) <br /> I have also notified my BC & R SH representative via phone and/or fax . <br /> Name of RC : f0V I <br /> Nam �S �'� c ar P <br /> r e of R H pecial �sts 1r1 <br /> Notes . <br /> In addition to faking in the ( legible) inspection report, please place a copy of the notice <br /> into the Detail Facility Compliance Workbook under Section 9 " RFC Inspections " , <br /> Document Owner-OE ES Revision Data 9/14/2012 <br />