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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.siaov.org/ehd <br /> CONTINUATION FORM Page: 5 of 5 <br /> OFFICIAL INSPECTION REPORT Date: 06/04/14 <br /> Facility Address: 1711 E Yosemite Avenue, Manteca Program: UST <br /> SUMMARY OF VIOLATIONS <br /> CLASS I,CLASS II,or MINOR-Notice to Comply) <br /> Provided- <br /> - Schedule of FREE classes <br /> - Return to Compliance Certification form <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 /> 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 /> EHD Inspector: Received By: Title: <br /> v� ma'` <br /> EHD 23-02-003 Rev 04/19/12 CONTINUATION FORM <br />