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Awk <br />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.sjgov.org/ehd <br />Underground Storage Tank Program Inspection Report <br />Facility Name: <br />cility Address: <br />T14971I <br />Date: <br />COUNTRYSIDE LIQUORS & GAS <br />N HWY 88 LODI <br />March 31 2015 <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 />�A <br />ALL EHD TAF I E ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RATE <br />THI F IS SUBJECT TO REINSPECTION AT ANY TIME AT END'S CURRENT HOURLY RATE <br />Received By <br />Received By (printed name and title): <br />Dat . <br />(signature): <br />Rupinder Padda, ownert <br />Inspector <br />Inspector (printed name and title): <br />Inspector Phone: <br />(signature): <br />ARIS VELOSO, Senior REHS <br />(209) 468-3453 <br />Page 4 of 4 <br />