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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.org/ehd <br />CONTINUATION FORM <br />Page: 7 of 7 <br />OFFICIAL INSPECTION REPORT <br />Date: 03/25/13 <br />Facility Address: Arco Mossdale 444 West Mossdale Road, Lathrop <br />Program: UST <br />SUMMARY OF VIOLATIONS <br />CLASS I, CLASS II, or MINOR -Notice to Comply) <br />999. continue. Immediately submit all necessary follow up paperwork for the 2012 underground storage <br />tank to the EHD. <br />Submit to SJC EHD within 30 days (04/25/13): <br />1. one copy of the completed "Return to Compliance Certification" form for 2012 year <br />2. one copy of the completed "Return to Compliance Certification" form for 2013 year <br />3. a written corrective action statement for each of the above violations for 2012 year <br />4. a written corrective action statement for each of the above violations for 2013 year <br />3. requested/ supporting documentation <br />Note: <br />- CERS ID 10180551. Reporting on CERS on http://cers.calepa.ca.gov for HMPB & UST is passed due. <br />Submit immediately CERS Lead User Authorization form to EHD. Submit information online <br />immediately. Make appt with me if you need assistance. <br />- Annual UST compliance testing performed in March 2013 to coincide with the facility's past due annual <br />air quality compliance testing. Annual UST compliance testing must be performed annually next by <br />March 2014. <br />ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RATE. <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />EHD Inspector: 'Received <br />� -,— )j' -1K �3� <br />By: <br />, <br />Title: <br />EHD 23-02-003 Rev 04/19/12 CONTINUATION FORM <br />