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I <br />i <br />SAN JOAQUIN COUNTY <br />t ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, California 95202-3029 <br />TokpAimm. (209) 468-3420 Fax. (209) 468-3433 Web. www.siaoy.orci/ehd/unitiii.htmi <br />CONTINUATION FORM Page: 4 of 4 <br />OFFICIAL INSPECTION REPORT Date: 07/28/11 <br />Facility Address: 1612 W Hammer Lane Program: UST <br />SUMMARY OF VIOLATIONS <br />(CLASS 1, CLASS 11, or MINOR -Notice to Comply) <br />Notes <br />1. Complete and submit a copy of the Return to Compliance Certification form with a statement of how <br />each violation was corrected, including supporting documentation, by August 28, 2011. <br />2. The line leak detectors and sensor positive shutdown could not be tested today since the store is <br />under construction, fuel is not being dispensed, turbines could not be authorized and the tanks contain a <br />small amount of fuel. Schedule the line leak detector test and positive shutdown test when the station is <br />in a.condition to test them, before opening the station for business. Notify the EHD. The annual <br />monitoring system certification is due by the end of July 2011. <br />NV <br />2 > m <br />Q Q O `� ❑ N <br />U <br />U <br />L 7 <br />rmu <br />1 <br />D r <br />v ru <br />N ri <br />C3 <br />C3 <br />U.S. Postal <br />Service <br />m�dc°1:6 <br />0� <br />QRZ <br />- N U O <br />N <br />�j0 <br />E .Ln <br />� <br />� <br />;:� � 3t (D <br />o <br />(Domestic <br />CY <br />av Ync <br />E E O N O <br />• <br />:D CD <br />CD 0 <br />O N <br />UC Lo <br />Orn <br />Ya Q <br />Q <br />LID V) <br />at www.usps.cornl,. <br />For delivery <br />information <br />U <br />U <br />L 7 <br />rmu <br />1 <br />D r <br />v ru <br />N ri <br />C3 <br />C3 <br />v LI <br />U.S. Postal <br />Service <br />M <br />0� <br />�p Return Receipt Fee Here <br />r=l <br />CERTIFIED <br />MAIL,,, <br />-rIC3 <br />RECEIPT <br />Restricted Delivery Fee <br />(Endorsement Required) <br />Q' <br />(Domestic <br />Mail Only; <br />No Insurance <br />Coverage Provide <br />M <br />PAUL TIWANA <br />at www.usps.cornl,. <br />For delivery <br />information <br />visit <br />our website <br />co <br />RE: 1612 WHAMMERLN RTN:GB <br />LL- <br />N C <br />T <br />v LI <br />:3 <br />Certified ee <br />Postmark <br />M <br />0� <br />�p Return Receipt Fee Here <br />r=l <br />B <br />C3 (Endorsement Required) <br />-rIC3 <br />Restricted Delivery Fee <br />(Endorsement Required) <br />Q' <br />o <br />Q <br />= Total P—Mnw R Gocc <br />M <br />PAUL TIWANA <br />sBnf <br />`r' 5500 QUASHNICK RD --------•- <br />0 <br />0Lpo STOCKTON CA 9521 _....___-. <br />cli <br />co <br />RE: 1612 WHAMMERLN RTN:GB <br />LL- <br />N C <br />T <br />O <br />M , BY THE ABOVE NOTED DATES tltllLL BE BILLED AT THE CURREWr HOURLY RATE. <br />IrION AT ANY TIME AT EHIYS CURRENT HOURLY RATE. <br />S? C <br />a u served By: Title: <br />N <br />EHD 23e02 -W3 Rev 07/12/11 CONTINUATION FORM <br />