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MW <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.ora/ehd <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Address: Date: <br /> CHEVRON#208117** 755 S TRACY BLVD TRACY February 10 2016 <br /> to be scheduled at an hourly rate of$130 per hour. <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, by March 11, 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 THIS <br /> FACILITY BACK INTO COMPLIANCE. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE <br /> Received by: p Date: February 10, 2016 Inspector: Inspector Phone: <br /> Printed Name and Title: VICKI MCCARTNEY, Senior REHS (209)468-9852 <br /> Andrea Evans, Manager <br /> Page 5 of 5 <br />