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0 SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, California 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www,sigov.ora/ehd/unitiii.html <br />CONTINUATION FORM <br />Page: 3 of 3 <br />OFFICIAL INSPECTION P T <br />Date: 02/04/11 <br />Program: UST <br />Facility Address: Chevron Station #201383 1960 West1lth Street, Tracy <br />SUMMARY OF VIOLATIONS <br />CLASS I, CLASS II, or MINOR -Notice to Comply) <br />UST Inspection: Routine and Annual Monitoring System Certification testing <br />No violations noted at this time <br />Notes: <br />1. Secondary containment testing due every three years, next due 04/2011. <br />2. Certification of Financial Responsibility and Letter of Chief Financial Officer due annually, next due <br />04/2011. <br />ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RATE ($122). <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />EHD Inspector: <br />,0A Aly— <br />Title: <br />momff <br />\-/ <br />EHD 2302-003 Rev 08/10/10 CONTINUATION FORM <br />