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'A <br />rage 4 or 4 <br />,-low 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.org/ehd <br />Underground Storage Tank Program Inspection Report <br />Facility Name: <br />Facility Address: <br />Date: <br />RMA17, <br />'373 <br />-en-Liiication of Financial Responsibility, U"-') f' Response Plan, uS [ 'Letter from Chief Financial Cjsif <br />applicable). and the Owner Statement of Designated Operator Compliance, The UST Owner/OpG: ator: WrItte, <br />Agreement, if applicable, can be stored at the facility or uploaded into CERS. <br />-')TES: <br />- On site for spill container testing. The spill container drain valve had to be cleaned and retested and it passed. <br />AFTER THE COMPLIANCE DATE, EHD WILL BILL FOR ALL TIME AND ACTIVITIES ASSOCIATED WITH BRINGING <br />THIS FACILITY BACK INTO COMPLIANCE <br />(-alTY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD-S CURRENT HOURLY RAT� <br />THIS FL <br />Received By'Received By (printed name and title): <br />Date: <br />(signature):�",�� <br />InspectorAC Inspector (printed name and title): <br />Inspector Phone: <br />(signature): &Ixj� =A ATINAH ZAP F. REHS <br />x 2 <br />rage 4 or 4 <br />