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Waste Antifreeze 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 Antifreeze Tank MAR 02 <br />ENVIRONME <br />yr t, -'u riF A <br />Date of Inspection(s)/Assessment: <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 violations. <br />Engineer's Name: Mike Smith Engineering, Inc. <br />License Number: 44590 O pR61 5 py <br />License Type: R.C.E. s�4Q� P�,� 04L, F <br />Address of Engineer: 4. N. Main St./P.O. Box 611 V`r <br />Lodi, Ca 95240 m <br />* 90 <br />Inspector name (if supervised by R 3- 1-16 �k <br />assessor above) dTgl CI V I L1'< <br />�P <br />F <br />OF CAL�¢� <br />Date Stamped/Signed <br />MAR 2 2016 <br />EL) <br />NTAL <br />RT <br />kAGNT <br />San Joaquin County HHW Facility�nY 7j,��A1?tifreeze Tank <br />,`ri uYti Y r..- <br />