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000238 <br /> 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.orq/ehd/unitiii.html <br /> CONTINUATION FORM Page: 3 of 3 <br /> OFFICIAL INSPECTION REPORT Date: 36/14/11 <br /> Facility Address: 1532 N. Broadway, Stockton Program: UST <br /> SUMMARYL ©Tl�.�__..ONS __ <br /> CLASS I,CLASS II om 1 <br /> This i_s_ he revision of the original Inspection repo _, generated on June 14. 2011.. <br /> The version superseders l�_pre r ous_tiers os. <br /> This is a routine and monitoring certification inspection. The following is a Minor-Notice to Comply: #3 <br /> 3. UST facility and tank forms on file with the EHD are not current. <br /> -- Any change of information on these forms must be submitted to the EHD within 30 days of the <br /> changes. <br /> * Immediately complete and submit a copy of the facility and tank forms to the EHD by July 15, 2011. <br /> Complete a separate tank form for each tank. For your convenience, a blank copy of the most current <br /> facility and tank forms have been provided to Kasi Montgomery by email on June 15, 2011, <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, by July 15, 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 /> EHDI pec Received By: / Title: <br /> EI-115/23-OF <br /> H 23-0 - 0 Rev 07 <br /> CONTINUATION FORM <br />