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Facility Name: <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.smg-o org/ehd <br />Underground Storage Tank Program Inspection Report <br />PRIS <br />Facility Address: <br />1605 S EL DORADO S -T S <br />Date: <br />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 <br />Designated <br />Op moor C into CERS. The UST Owner/Operator: Written <br />Agreement, if applicable, can be stored at the <br />Provided: Return to Compliance Certification <br />ALL EHD STAFF TIME AJJVUlA I tv vvi i n �� - • - • - - <br />CILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RA <br />TE <br />ReceiOFA <br />Received By (printed name and title): Da(sign Staci Noble, Assistant Manager �finspector (printed name and title):Inspector Phone: <br />nspe 209 468-3440 <br />STACY RIVERA, Senior REHS ( ) <br />Page 5 of 5 <br />