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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.sjgov.org/ehd <br /> �rgraund Storage Ta ► gall ' n p pt on Report v <br /> Facility Name: Facility Address: Date: <br /> Dino Mart 1001 E YOSEMITE AVE, MANTECA March 09, 2017 <br /> paperwork, by 4-9-2017. <br /> Please be aware that as of January 1, 2014, facility operators are required to upload the following UST program <br /> documents into the California Environmental Reporting System (CERS): UST Monitoring Site Plan, UST <br /> Certification of Financial Responsibility, UST Response Plan, UST Letter from Chief Financial Officer(if <br /> applicable), and the Owner Statement of Designated Operator Compliance. The UST Owner/Operator: Written <br /> Agreement, if applicable, can be stored at the facility or uploaded into CERS. <br /> NOTE: the permit fees for the UST operating permit have not been paid yet, please be advised that no permit to <br /> operate will be issued until all fees are paid and the site is in compliance with all applicable regulations. <br /> AFTER THE COMPLIANCE DATE, EHD WILL BILL FOR ALL TIME AND ACTIVITIES ASSOCIATED WITH BRINGING <br /> THIS FACILITY BACK INTO COMPLIANCE. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE <br /> Received by: <br /> �,1 cl� ef(1'1 Cee Date: Inspector: Inspector Phone: <br /> d�!J Qf) - Printed Name and Title: ELENA MANZO, Lead Senior REHS (209) 953-7699 <br /> M GQ <br /> FA0000421 PR0231876 SCO01 03/09/2017 <br /> EHD 23-01 Rev.09/22/16 Page 6 of 6 Underground Storage Tank Program OIR <br />