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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, California 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sogov.org/ehd/unitiii.html <br /> CONTINUATION FORM Page: 3 of 3 <br /> OFFICIAL INSPECTION REPORT Date: 01/28/11 <br /> Facility Address: 1001 E. Yosemite Ave., Manteca Program: UST <br /> SUMMARY OF VIOLATIONS <br /> CLASS I,CLASS II,or MINOR-Notice to Comply) <br /> ROUTINE ANNUAL INSPECTION & MONITORING SYSTEM CERTIFICATION <br /> Violations: (4, 13) <br /> 4. Financial responsibility documents have not been submitted to the EHD. Financial responsibility <br /> documents were last received by EHD on July 9, 2009. Current financial responsibility documents are <br /> required to be submitted annually. Complete and submit a copy of the financial responsibility by <br /> February 28, 2011. <br /> 13. The Bravo box float and chain in the UDC 5/6 (north) sump failed to stop the flow of product at the <br /> dispenser when tested. All monitoring equipment shall be maintained to activate an audible and visual <br /> alarm or stop the flow of product at the dispenser when it detects a leak. The service technician <br /> adjusted the float and verified functionality. <br /> Complete & submit a copy of the Return to Compliance Certification to the EHD by February 28, 2011 <br /> along with a statement documenting the corrective actions that have been or will be taken for each <br /> violation and any supporting paperwork. <br /> Note: Facility may be changing ownership from individual to corporation in the near future. A new <br /> facility (A) form should be submitted to EHD at that time. <br /> Provided: <br /> - Return to Compliance Certification form <br /> - Facility (A) form <br /> - Financial Responsibility & CFO Letter forms <br /> ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RATE($122). <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME ATE D'S CURRENT HOURLY RATE. <br /> EHD Inspector: Received I J» Title: Ow yfe <br /> �I tl a n <br /> CS <br /> EHDt2 #2v 08/10/10 CONTINUATION FORM <br />