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A NJ O A Q U l N Environmental Health Department <br /> COUNTY— V AMENDED <br /> 6/22/2021 <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Address: Date: <br /> COUNTRY MART GAS&FOOD 34243 S CHRISMAN RD, TRACY June 23, 2021 <br /> To minimize person to person contact EHD is choosing to write the name of person receiving the report instead <br /> of having them sign. Starting September 1, 2018, all in-office CERS help will be provided at EHD hourly rate <br /> ($152). To schedule an appointment, please call (209)468-3420. <br /> NOTE: All EHD staff time associated with a re-inspection will be billed at the current hourly rate ($152). A 48 <br /> hour written notice of inspection must be provided to EHD prior to testing. <br /> Documents provided during inspection: <br /> - blank Designated Operator Identification form <br /> - blank Statement of Understanding and Compliance form <br /> - blank Certificate of Financial Responsibility form <br /> - blank Letter from Chief Financial Officer <br /> - list of free CUPA Classes <br /> CERS assistance was provided during the inspection today. The CDTFA number, DO form, Statement of <br /> Understanding and Compliance, Financial Responsibility documents were uploaded into CERS during the <br /> inspection today. <br /> Inspection report will be mailed to facility per request of owner. <br /> AFTER THE COMPLIANCE DATE, EHD WILL BILL FOR ALL TIME AND ACTIVITIES ASSOCIATED WITH BRINGING <br /> THIS FACILITY BACK INTO COMPLIANCE. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> Received by: Date: Inspector: Inspector Phone: <br /> Printed Name and Title: CAROL PRESTO, EH Specialist (209)616-3061 <br /> FA0003290 PR0231801 SCO01 06/23/2021 <br /> EHD 23-01 Rev.9/16/2020 Page 7 of 7 Underground Storage Tank Program OIR <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />