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Nftw� <br />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, Califomia95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.org/ehd <br />Underground Storage Tank Program Inspection Report <br />Facility Name: <br />Facility Address: <br />Date: <br />KE' <br />giber 26. 2u1: <br />SUMMARY OF VIOLATIONS <br />(CLASS I, CLASS II, or MINOR - Notice to Comply) <br />Item # <br />Remarks <br />CCR 2715 Designated operator monthly inspection reports not maintained on site for at least 12 months. <br />The November and December 2014 designated operator monthly inspection reports were not tound on site. <br />Designated operator monthly inspection reports for the previous twelve months shall be retained on site. Locate and <br />ensure that copies of the previous twelve months of designated operator monthly inspection reports are maintained on <br />site. Submit copies to the EHD. <br />This is a minor violation <br />Overall Inspection Comments: <br />On site to conduct the rou, I and witness the annual monitoring system certification testing. <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 11-26-15. <br />Please be aware that as of January 1, 2014, facility operators are required to upload the following UST progran <br />documents into the California Environmental Reporting System (CERS): UST Monitoring Site Plan, UST <br />Certification of Financial Responsibility, UST Response Plan, UST Letter from Chief Financial Officer (if <br />applicable), and the Owner Statement of Designated Operator Compliance. The UST Owner/Operator: Written <br />Agreement, if applicable, can be stored at the facility or uploaded into CERS. <br />ALLEHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILLBE BILLEDATTHE CURRENT L . <br />THIS FACILITY IS SUBJECT TO REINSPECTION ATANY TIME AT EHD'S CURRENT HOURLY RATE. <br />Received B <br />Received By (printed name and title): <br />Date, zu <br />�� <br />(Signatu <br />Inspector <br />Inspector (printed name and title): <br />Inspector Phone: <br />(signature): <br />ISO, Senior RF' <br />(209) 468-3453 <br />Page 5 of 5 <br />