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ink and Secondary Containment <br /> Assessment Document <br /> EUI <br /> This document was prepared for: OCT 0 9 2 15 <br /> Company Name: Sanborn Chevrolet ENVIRONM NT <br /> N I <br /> Address: 1210 S. Cherokee Lane yF'"TW nPpn OT p(„ <br /> City, California ZIP: Lodi, Ca 95240 ��NT <br /> Tank/System Identification: <br /> Used Antifreeze <br /> Date of Inspection(s)/Assessment: <br /> 7/29/2015 <br /> This report consists of 28 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 manage 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 /> Engineer's Name: Mike Smith Engineering, Inc. <br /> License Number: 44590 �0 P 5��'C�) {` <br /> License Type: R.C.E. <br /> Address of Engineer: 4. N. Main St./P.O. Box 611 <br /> r� <br /> Cl <br /> Lodi, Ca 95240 an <br /> 'CJ in <br /> y. ado. 04 rr1 ZU <br /> Inspector name (if supervised by l.� L,P3 <br /> assessor above) '�- <br /> y� /VIL <br /> CAU <br /> Date Stamped/Signed <br /> i <br /> Sanborn Chevrolet Page 1 Used Antifreeze <br />