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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:www.segov.ora/ehd <br /> Facility Name: Facility Address: Date: <br /> FLYING J TRAVEL PLAZA 1618* <br /> =1501N JACK TONE RD RIPON Ma 14 2015 <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 /> ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RATE <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE <br /> Received ByReceived By(printed name and title): Date: <br /> (signature): �/j a vN,-ta Bryan Cairns, Manager <br /> Inspector Inspector(printed name and title): Inspector Phone: <br /> (signature): ELENA MANZO, REHS (209) 953-7699 <br /> Page 7 of 7 <br />