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0 SAN JOAQUIN COUNTY 0 <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sogov.org/ehd <br />CONTINUATION FORM <br />Page: 4 of 4 <br />OFFICIAL INSPECTION REPORT <br />Date: 08/30/12 <br />Facility Address: 1330 Yosemite Avenue, Manteca <br />Program: UST <br />SUMMARY OF VIOLATIONS <br />CLASS 1, CLASS II, or MINOR -Notice to Comply) <br />Notes <br />Complete and submit a copy of the Return to Compliance Certification form with a statement of how <br />each violation was corrected, including supporting documentation, to the EHD within 30 days of <br />receiving this report. <br />The financial responsibility Certification and the CFO letter was provided during inspection. This is an <br />annual requirement. <br />ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RATE. <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT AN IME AT EHD'S CURRENT HOURLY RATE. <br />EHD Inspector. <br />Recei <br />I Title: <br />c, <br />64— <br />EHD 23-02-003 Rev 04/19/12 V I // CONTINUATION FORM <br />