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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.sigov.org/ehd <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Address: Date: <br /> CALIFORNIA STOP* 12224 MANTHEY RD STOCKTON March 16 2015 <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 /> Provided: Return to Compliance Certification Form, schedule of free CUPA classes, Unauthorized release form <br /> ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RAT <br /> THIS FACILITY 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): Nancy Le, Owner "— <br /> Inspector Inspector(printed name and title): Inspector Phone: <br /> (signatur STACY RIVERA, Senior REHS (209) 468-3440 <br /> Page 6 of 6 <br />