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SAN JOAQUIN <br />C:OU NTY <br />Environmental Health Department <br />Underground Storage Tank Program Inspection Report <br />Facility Name: <br />Facility Address: <br />1 <br />Date: <br />QUIK STOP MARKET #551121 <br />1196 W LOUISE AVE, MANTECA <br />May 19, 2021 <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 06/18/2021. <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 />Documents provided during inspection: Return to compliance certification form, corrective action statement form <br />and a list of approve free CUPA training classes. <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: May 19, 2021 <br />Inspector: <br />Inspector Phone: <br />Printed Name and Title: <br />PAUL NSO, EH Specialist <br />(209) 616-3049 <br />Kuljit Gill, Manager <br />FA0000848 PR0231430 SCO01 05/19/2021 <br />EHD 23-01 Rev. 9/16/2020 Page 6 of 6 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 />