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S A N J U A Q U I N Environmental Health Department <br /> U 1\� I <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Address : <br /> VDte7- ELEVEN INC #20632 4627 DA VINCI DR , STOCKTON mber 13 , 2022 <br /> Other Violations <br /> 2010 See below Unlisted General violation ❑ V ❑ R ❑ COS <br /> SUMMARY OF VIOLATIONS <br /> (CLASS I , CLASS 11 , or MINOR - Notice to Comply) <br /> Item # Remarks <br /> Overall Inspection Comments : <br /> An inspection checklist was provided to the facility operator at the time of inspection . The inspector will provide <br /> a complete report to the facility operator within the next few weeks . <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 , within 30 days of receiving the complete inspection report . <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 /> ($ 156) . To schedule an appointment , please call (209 ) 468-3420 . <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 T REINSPECTION AT ANY TIME AT EHD' S CURRENT HOURLY RATE. <br /> Received by : Date: ( Inspector: Inspector Phone: <br /> 9 `'�` <br /> Printed Name and and Ti� SHEWIT WOLDEAREGAY , EH Specialist Q - <br /> go <br /> FA0002541 PR0231074 SC001 12/13/2022 <br /> EHD 23-01 Rev. 9/20/2019 Page 4 of 4 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. sjcehd . com <br />