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IV <br />San Joaquin County k <br />Environmental Health Department AME,V. F <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.orglehd <br />Underground Storage Tank Program Inspection Report <br />Facility Name: <br />Facility Address: <br />Date: <br />CHEVRON STATION 4210997' <br />1442 Colony Dr RIPON <br />January 21 2016 <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 />AFTER THE COMPLIANCE DATE, EHD WILL BILL FOR ALL TIME AND ACTIVITIES ASSOCIATED WITH BRINGING THIS <br />FACILITY BACK INTO COMPLIANCE. <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE <br />Received by: Date: <br />Inspector: <br />Inspector Phone: <br />+ <br />l�4 Q Printed Name and Title: <br />ELENA MANZO, Senior REHS <br />(209) 953-7699 <br />Page 4 of 4 <br />