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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.or /g ehd <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Address: Date: <br /> CHEVRON STATION 4201383 1 1960 W ELEVENTH ST, TRACY I February 06, 2015 <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 Owner/Operator: Written Agreement(if <br /> applicable), UST Letter from Chief Financial Officer, and Owner Statement of Designated UST Operator <br /> Compliance. <br /> ALL EHD STAFF TIME ASSOCIATED WITH FAILING To COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE <br /> HI FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE <br /> ' ( •g Title: � <br /> Date, <br /> Yoe 6 <br /> ,,� <br /> 17 — qmri �- L) <br /> Received By(printed me): Inspector: Ins ct Phone: <br /> MICHELLE HENRY, Senior REH�..� - (209)468-3454 <br /> Page 4 of 4 / <br /> J <br />