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ja 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 />Facility Address: <br />1755 <br />Date: <br />CHEVRON #208117"* <br />S TRACY BLVD, TRACY <br />February 23, 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 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 />ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVr NOTED DATES WILL BE 13ILLED AT THE CURRENT HOURLY RATE <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE <br />Rece�B(snature): <br />cky-4 <br />Title: <br />SAO'j "-P� <br />Date: <br />Z`25'2015 <br />Receiveh By (printed name): <br />Inspector: <br />Inspector Phone: <br />STACY RIVERA, Senior RE <br />(209) 468-3440 <br />Page 5 of 5 <br />