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Agency,ins pcion Report Fax Cover Sheet <br />(Please fax in.&L Agency Irmpection Repd(b�vwtb or Without corrective actiorrs) <br />04/201.4 <br />JkATE: <br />TO.: Pelim It Desk <br />FAX: (925) 842-9685 or (925) 842-5690 <br />Pages-. 5 <br />(including cover) <br />FROM: Station208117 -.1718 <br />,(Chevr,on F cility #) t (C -Sl <br />Phone Num.- bar: 209-830-0370 <br />PrInt Manager Name:. Kitty Carter <br />I - <br />a violation or condition that requires a corrective action by a specified date and, required p"nt of a <br />monetary -fitne or penalty. <br />NTC - Notice iso ,CoMply: A document issued by a Government or Local Agency identifying a <br />violation or condition of non-compliance that requires a, corrective action by a specific date but does <br />not levy a monetary fine or penalty. <br />0 Other: 100% or Any Government or Local Agency document or communication (these <br />include a successfully passed inspection) <br />Name of BC: Diane Province <br />Name of Retail OE/HES -SpLmcialist: Ed Dahlgren <br />Notes: <br />fn addition to faXirig in the (legible)- Inspectio.n report, ptoasa place report into the <br />Retail Facilit-y Compliance Workbook under Section 9 'IRFC inspections°'. <br />AGENCY INSPECTION REPORT FAX COVER SHEET - V1, 0312012. <br />DOCUMENT OWNER OE/HES PERMIT DESK <br />