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San Joaquin County e -' <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 />Underground Storage Tank Program, inspection Report <br />Facility Name: <br />Facility Address: <br />Date: <br />KAISER FOUNDATION - MANTECA <br />1777 W YOSEMITE AVE, MANTECA <br />July 08, 2016 <br />complete report which replaces the initial checklist. <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, within 30 days of receiving the complete inspection report. <br />AFTER THE COMPLIANCE DATE, EHD WILL BILL FOR ALL TIME AND ACTIVITIES ASSOCIATED WITH BRINGING THIS <br />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 />V� nP,Q • M44V Printed Name and Title: <br />Di l. <br />ELENA MANZO, Senior REHS <br />(209) 953-7699 <br />Page 4 of 4 <br />