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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.s04ov.org/ehd <br />d �� am InSpeClll I <br />Facility Name: Illacility Address: Date. <br />LAWRENCE LIVERMORE NATIONAL LAB - 5999 W CORRAL HOLLOW RD, TRACY August 01, 2017 <br />Overall Inspection Comments: <br />Complete and submit a copy of the Return to Compliance Certification form to the EHD with a statement <br />documenting the corrective actions that have been or will be taken for each violation, and any supporting <br />paperwork, by August 31 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 />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: Date: <br />Inspector: <br />Inspector Phone: <br />Printed Name and Title: <br />CESAR RUVALCABA, EHS Trainee <br />(209) 953-6213 <br />EHD 23-01 Rev. 09/22/16 <br />Page 4 of 4 <br />FA0003934 PR0231945 SCO01 08/01/2017 <br />Underground Storage Tank Program OIR <br />