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Ak <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.sjgov.orq/ehd <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: F601 <br /> cility Address: Date: <br /> KETTLEMAN CHEVRON E KETTLEMAN LN LODI July 22 2015 <br /> Overall Inspection Comments: <br /> On site to conduct a routine UST inspection and witness the annual monitoring system certification testing. <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, by 8-22-15. <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 /> ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RATE <br /> THIS,FAQ41TY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE <br /> Received By Received By(printed name and title): Date: <br /> (signature): Harvinder Pal Singh, owner <br /> Inspector Inspector(printed name and title): Inspector Phone: <br /> (signature): ARIS VELOSO, Senior REHS (209)468-3453 <br /> Page 5 of 5 <br />