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Ift <br />lqw San Joaquin County `W <br />Environmental Health Department ARMENDEU <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 �, - ;� I 16 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd <br />Facility Name: Facility Address: Date: <br />QUIK STOP MARKET #2120* 9321 N THORNTON RD STOCKTON I May 04, 20 <br />The amended report replaces the initial report. <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 amended inspection report. <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 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: Inspector: Inspector Phone: <br />E e Printed Name and Title: VICKI MCCARTNEY, Senior REHS (209) 468-9852 <br />Page 6 of 6 <br />