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d'1/14/2014 14:4U 'l bbl UHLVRUN HAUL UI/Ob <br /> envy Inspection Report Fax <br /> (Please fax in&6 Agency Inspection Reports with or without corrective actions) <br /> DATE: 1 - 114- 15 Pages: 5 <br /> (Including cover) <br /> Permit Desk <br /> FAX ( ) - or (925) 842-6660 <br /> Station i i <br /> (Chevron cili ) / (CSI ) <br /> Phone Number: <br /> Print Manager Name: Ir>a ' <br /> My facility received the attached (check appropriately below): <br /> OV-Notice of Violation: A document issued by a Government or Local Agency identifying a <br /> violation or condition that requires a corrective action by a spovified date and may require payment of a <br /> monetary fine or penalty. <br /> C-Notice to Comply: A document issued by a Government or Local Agency identifying a <br /> violation or condition of non-compliance that requires a corrective action by a specific date but does not levy a <br /> monetary fine or penalty. <br /> (Jtlrer: ;100%or Any Government or Local Agency document or communication(these include a <br /> ccesSty passed inspvotion) <br /> I have also notified my BC & RESHrepresentative via phone and/or fax. <br /> Name of C: 1 au 'pod,"'c a <br /> Name of RESH Specialist: &krovib <br /> Notes: <br /> EGO <br /> JAN , °DC�ti4 <br /> In addition to faxing in the {legible} inspection report, please place a AM otice <br /> into the Retail Facility Compliance Workbook under Section E "RFC Inspections". <br /> Document Owner-OF HES Revision Date 9/14/2012 <br />