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Model <br /> Tank and Secondary Containment <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 /> Lich C71646 55�pNAL E <br /> CA Civil PE QQoO�N K.B <br /> 2522 Grand Canal Blvd. Q <br /> Suite 14 <br /> Stockton,CA 95207 * 71646 <br /> ST�T� Civ 1 L <br /> \F <br /> EC `'" °'� <br /> Date stamped/signed: 8/1/17 <br /> AUu 0 <br /> ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br /> Sanborn Chevrolet Used Motor Oil <br /> 1 <br />