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San Joaquin County qw <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, California95205-6232 <br />Telephone. (209) 468-3420 Fax: (209) 468-3433 Web. www-siqov.orCj/ehd <br />Underground Storage Tank Program Inspection Report <br />Facility Name: Facility Address: Date: -n,- <br />J E'��'- I Decet bf <br />-a aware that as o; . :,�-ivary 1, zlj j!4, ia,'-iilty opei,,,t�I.� �u;' --e toiiowing Uz:3 <br />ju��urrients into the Californ,, Environmental Reporting System( _ir� S): I g Site Plan, UST <br />Certification of Financial Responsibility, UST Response Plan, UST Letter from Chief Financial OfficeKif <br />alDplicable), and the Owner Statement of Designated Operator Compliance The UST Owner/OperatorWritten <br />Agreement, if applicable, can be stored at the facility or uploaded into CER S. <br />Note: The ball float cap was removed and the ball float was observed inside the91-octane vapor container, the <br />ball float cap Could not be opened for observation on the87-octane UST. Ensure that ball float functionality <br />could be verified at the time of inspection. <br />!'.,FTER THE COMPLIANCE DATE, EHD WILL BILL FOR ALL TIME AND ACTIVITIES ASSOCIATED WITH BRINGING <br />THIS HIS FACILITY BACK INTO COMPLIANCE <br />THIS FACILITA 1.UBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE <br />Received By I Received By (printed name and title): FD—ate- - I <br />H u r. <br />(signature): <br />I I 1 111111 --53 <br />Inspector � 1111' Inspector (printeci name anu uI c ) <br />11A�1� r'LIHS -769 <br />(signature): <br />I I <br />