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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:MMjjggy.oMftW <br /> Undergrotind Storage Tank Program Inspection Report <br /> Facility Name: Facility Address: Date: <br /> CHEVRON#208117'* 755 S TRACY BLVD,TRACY February 23, 2015 <br /> i <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(CRS): UST Monitoring Site Plan, UST <br /> Certification of Financial Responsibility, UST Response Plan, UST Owner/Operator: Written Agreement(if <br /> applicable), UST Letter from Chief Financial Officer, and Owner Statement of Designated UST Operator <br /> Compliance, <br /> Provided: Return to Compliance Certification form <br /> i <br /> ALL EHD 5TAFF MME AS NG TO cONM By THE ASUVE NOTED WM VVILL 13E EM 0 A7 TRE COMM HOURLY WE <br /> i <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANYTIME AT EHD'S CURRENT HOURLY RATE <br /> ---- <br /> Racal tSignature): Title. Date- <br /> K—mlved By <br /> 1printed name): Inspecton Inapector one: <br /> STACY RIVE Senior RE (209)468- 0 <br /> Page 5 of 5 <br /> a <br /> t <br /> S <br />