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Waste Oil Tank and <br />Secondary Containment <br />Assessment Document <br />This document was prepared for: <br />Company Name: San Joaquin County Household Hazardous Waste Facility <br />Address: 7850 R A Bridgeford Street <br />City, California ZIP: Stockton, Ca 95206 <br />Tank/system identification: <br />Waste Oil REGJ � /1 <br />MAR 0 2 2016 <br />Date ofInspection(s)/Assessment: u=a,Tu-%roa lUF <br />9/2/2015 <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 17 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 vi tions. <br />Engineer's Name: Mike Smith Engineering, Inc. Q�OFE S10N <br />License Number: 44590 S <br />License Type: R.C.E. <br />Address of Engineer: 4. N. Main St./P.O. Box 611 VZ O m <br />Lodi, Ca 95240 Cf1 p <br />o{{ CO 0 <br />inspector name (if supervised by * EJCR 1 16 <br />assessor above) <br />9TF OF CAVy��� <br />Date Stamped/Signed <br />V <br />X <br />AL <br />T <br />s(oz 9 -avyl <br />��•A .A 1. <br />San Joaquin County HHW Facility �_' _r :r "WastLOil Taiik <br />