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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.sogov.org/ehd <br />z a <br />:_ 10 <br />Facility Name: Facility Address: Date: <br />TESORO (SHELL) 68151 35 N CHEROKEE LN, LODI January 26, 2016 <br />paperwork, by February 25, 2016. <br />Please be aware that as of January 1, 2014, facility operators are required to upload the following UST program <br />documents into the California Environmental Reporting System (CERS): UST Monitoring Site Plan, UST <br />Certification of Financial Responsibility, UST Response Plan, UST Letter from Chief Financial Officer(if <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 />AFTER THE COMPLIANCE DATE, EHD WILL BILL FOR ALL TIME AND ACTIVITIES ASSOCIATED WITH BRINGING <br />THIS FACILITY BACK INTO COMPLIANCE. <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE <br />Received By /'� <br />(signature): <br />��;�� O C PV <br />Received By (printed name and title): <br />Jennifer Rodriguez, Manager <br />Date: r, / i <br />/`✓ G <br />1 \ l I <br />Inspector <br />Inspector (printed name and title): <br />Inspector Phone: <br />(signature): <br />VICKI MCCARTNEY, Senior REHS <br />(209) 468-9852 <br />V Nage 5 of 5 <br />