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COMPLIANCE INFO_2010-2012
Environmental Health - Public
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2300 - Underground Storage Tank Program
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PR0231784
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COMPLIANCE INFO_2010-2012
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Last modified
12/4/2023 3:49:58 PM
Creation date
6/23/2020 6:52:22 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2010-2012
RECORD_ID
PR0231784
PE
2361
FACILITY_ID
FA0003834
FACILITY_NAME
PACIFIC AVE CHEVRON
STREET_NUMBER
6633
STREET_NAME
PACIFIC
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
APN
097-410-48
CURRENT_STATUS
01
SITE_LOCATION
6633 PACIFIC AVE
P_LOCATION
99
P_DISTRICT
002
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0231784_6633 PACIFIC_2010-2012.tif
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EHD - Public
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f SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202 <br /> Telephone: (209)468-3420 Fax: (209)468-3433 Web: www.s,gov_aMg/mhd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply" in the attached inspection report must be corrected <br /> within 30 days of receipt of this inspection. This certification form must be submitted to the Environmental <br /> Health Department(EHD)address at the top of this form within 35 days of receipt of the inspection report. <br /> All corrections to other violations noted in the attached Inspection Report(IR)or Continuation Form, or <br /> disputes to any violations, are to be submitted using this certification and returned to EHD within 30 days <br /> unless otherwise specified in the IR. <br /> For this certification t0 be complete the operator of the site must include: <br /> • A statement documenting what corrective actions were taken or will be taken for each violation <br /> • Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos <br /> verifying corrections <br /> • Operator's certification <br /> Inspection Date: January 12, 2011 Inspected By: Garrett Backus <br /> Facility Address:6633 Pacific Ave. Stockton, Ca 95207 EPA ID#: CAR000125278 <br /> I certify under penalty of law that: <br /> 1. I have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. I have personally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and I believe the information to be true, accurate, and complete: <br /> Photos X Paperwork_X Statement <br /> 3. I am authorized to submit this certification on behalf of the Respondent. <br /> 4. I am aware that there are significant penalties for submitting false information, including the <br /> possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br /> Name: Andrea Vilchis Title: UST Compliance Coordinator <br /> Signature: c' z,El�, ( C -CL�� Date: February 15, 2011 <br />
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