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rNE17' 7 <br /> Lw I V iNY,;- �IVdK <br /> 7". ' ;]IANOHIAN::� <br /> HiIV3H <br /> AUG 112017 <br /> Model 90V <br /> ENVIRONMENTAL HEALTH <br /> Tank and Secondary Containment <br /> DEPARTMENT Cl <br /> Assessment Document <br /> This document was prepared for: <br /> SANBORN CHEVROLET <br /> 1210 Cherokee Lane <br /> Lodi, CA 95240 <br /> Tank/system identification: <br /> Used Motor Oil <br /> Date of inspection(s)/assessment: <br /> Include all inspection and/or assessment dates. Please include any dates used <br /> to confirm data or to examine changes made to tank or system as a result of <br /> recommended corrections. <br /> This report consists of 9 pages. <br /> I certify under penalty of law that this document and all attachments were prepared under my <br /> direction or supervision in accordance with a system designed to assure that qualified personnel <br /> properly gather and evaluate the information submitted. Based on my inquiry of the person or <br /> persons who mange the system, or those persons directly responsible for gathering the <br /> information, the information submitted is, to be the best of my knowledge and belief, true, <br /> accurate, and complete. I am aware that there are significant penalties for submitting false <br /> information, including the possibility of fine and imprisonment for knowing violations. <br /> Jordan K.Baldwin <br /> Lic# C71646 <br /> �ONAL <br /> CA Civil PE K. <br /> 2522 Grand Canal Blvd. <br /> Suite 14 N 71546 <br /> Stockton, CA 95207 <br /> OF <br /> Date stameed/signed: 8/1/17 <br /> Sanborn Chevrolet Used Motor Oil <br /> 1 <br />