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2015-07-27 13:59 <br />Facility Narno: <br />VAN DE FOL ENT I <br />FUEL U&IVERY 120923472952094683433 <br />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., wwwgjNv.gM&b1 <br />Underground Storage Tank Program Inspection Repoif <br />Facility Address- <br />�JPACIFIC PRIDE 351 N BECKMAN RD LnDI <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, by 7-25-15. <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 />-------THIS <br />Rocolved By <br />(signature): <br />(Signaturo): <br />TO E NSPECTION AT ANY TIME AT EH <br />I Rocolvod By (printed name and tltlo): <br />Ted Shackelford, Manager <br />Inspector (printod namo and title): <br />ARIS VELOSO, Senior RENS <br />Page 5 of 5 <br />(209) 468-3453 <br />