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Amok <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.org/ehd <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: T4344 <br /> cility Address: Date: <br /> CHEVRON STATION #199840 E Waterloo Rd, STOCKTON January 07, 2015 <br /> component replacement), a permit from EHD is required. <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 Owner/Operator: Written Agreement(if <br /> applicable), UST Letter from Chief Financial Officer, and Owner Statement of Designated UST Operator <br /> Compliance. <br /> ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RATE <br /> Received By(signature): ,. Title. Date: <br /> Received Wy prints name): Inspector: Inspector Phone: <br /> JEFFREY WONG, Senior REHS (209) 468-0335 <br /> Page 4 of 4 <br />