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AMEND <br /> E <br /> S A RP O A Q U I N ` Environmental Health Department <br /> --� <br /> COUNTY- <br /> 61, <br /> OUtil1"Y— <br /> :: <br /> �tla' fund Sfa04&'fa�r ragr tranpReport <br /> w�. ._.. _ _. .. .Y. � . <br /> Facility Name: Facility Address: Date: <br /> Verizon Business: KINGCA 13850 N DE VRIES RD, LODI August 07,2018 <br /> Complete and submit a copy of the Return to Compliance Certification form to the EHD with a statement <br /> documenting the corrective actions that have been or will be taken for each violation, and any supporting <br /> paperwork within 30 days of receipt of the inspection report. <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 /> Consent granted through phone from Jonathon Pakele, Verizon Building Engineer. <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: Date: August 07,2018 Inspector: Inspector Phone: <br /> Printed Name and Title: AARON HANG, REHS (209)468-3453 <br /> Jonathan Pakele,Verizon Building Engineer <br /> FA0003848 PR0231547 SCO01 08/07/2018 <br /> EHD 23-01 Rev.10/31/2017 Page 4 of 4 Underground Storage Tank Program OIR <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />