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San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 468-3433 Web:www sjoov.org/ehd <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Address: Date: <br /> CHEVRON USA INC;~198264* 3775 N TRACY BLVD, TRACY February 17, 2015 <br /> Consent to perform the inspection, take photos and collect samples was given by Rajni Bala, cashier. This <br /> facility's designated operator is Zane Nimmo(Afforda-Test) ([CC expiration date: 3/2016 ) . The service <br /> technician was Ryan Casey (ICC expiration date: 2/2016 ), who had the following manufacturer's certifications: <br /> Veeder-Root 5/2016, Tanknology LDT-5000 112015 <br /> Please be aware that as of January 1, 2014, facility operators are required to upload the following UST program <br /> documents into the California Environmental Reporting System(CERS): UST Monitoring Site Plan, UST <br /> Certification of Financial Responsibility, UST Response Plan, UST Owner/Operator: Written Agreement(if <br /> applicable), UST Letter from Chief Financial Officer, and Owner Statement of Designated UST Operator <br /> Compliance. <br /> ALL EHU 6 IAFF I IME A6b0U1A1 ED WIT H FAILING TO COMPLY BY I HEABOVE NOTED DAI ES WILL BE BILLEDAT THE CURRENT HOURLY RATE <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE <br /> Received By(signature): Title: Date: <br /> Received By(printed name): Inspector: Inspector Phone: <br /> MICHELLE HENRY, Senior REHS (209)468-3454 <br /> Page 4 of 4 <br />