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Alk <br />Ak <br />qW San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, California95205-6232 <br />Telephone. (209) 468-3420 Fax: (209) 468-3433 Web. www.sigov.orq/ehd <br />Underground Storage Tank Program Inspection Report <br />Facility Name: <br />Facility Address- <br />Date: <br />,JR0 (M0BlL),-:,r <br />401 VV KETTLEMAN LN. LODI <br />Fohn jary 18, 2016 <br />nplete and submit a copy of the turn to Compliance Certification form to the Ei- . with a statement <br />,:urnenting the corrective actions inat have been or will be taken for each violation. as id any supporting <br />��perwork, by 3-17-16. <br />-'lease be aware that as of Januaryl, 2014, facility operators are required to upload the following UST program <br />,,ocuments into the California Environmental Reporting System(CERS): LIST Monitoring Site Plan. UST <br />�3ertification of Financial Responsibility, LIST 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: �ebruary 18. 21,1 <br />Inspector: <br />Inspector Phone: <br />Printed Name and Title: <br />-0�� VLLO��O, Senior RE! -!S <br />Ztr 468-34521; <br />PSton(_' atricia Morena, , , �nager <br />I <br />Page 4 of 4 <br />