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n <br />n <br />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.sj oq v.org/ehd <br />Underground Stora a Tank Pro raj Ins ect'on Report <br />Facility Name: <br />Facility Address: <br />Date: <br />COUNTRY CLUB FOOD &FUEL MINI MART* <br />1856 W COUNTRY CLUB BLVD STOCKTON <br />June 09 2016 <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 ATE, EHD WILL BILL FOR ALL TIME AND ACTIVITIES ASSOCIATED WITHBRINGING THIS <br />FACILITY BACK INTO COMPLIANCE. <br />THIS FACILITY IS SUBJECT TO REINSPECTIONT ANY TIME AT EH CURRENT H LY RATE <br />Received by: Date: <br />Inspector: <br />Inspector Phone: <br />Printed Name and Title: <br />FATINAH ZAREEF, RENS <br />(209) 953-7311 <br />Page 7 of 7 k-/ <br />