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Model <br /> Tank and Secondary Containment <br /> Assessment Document <br /> This document was prepared for: <br /> Ron's Auto Service <br /> 2553 N Hwy 99 <br /> West Frontage Rd <br /> Acampo, CA 95220 <br /> Tank/System identification: <br /> Used Motor Oil <br /> Date of inspection(s)/assessment: <br /> Include all inspections and/or assessment dates. Please include any dates used to confirm data or to examine <br /> changes made to tank or system as a result of recommended corrections. <br /> 10/25/2019 <br /> This report consists of 16 pages. <br /> I certify under penalty of law that this document and all attachments were prepared under my direction or <br /> supervision in accordance with a system designed to assure that qualified personnel properly gather and <br /> evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or <br /> those persons directly responsible for gathering the information the information submitted is,to be the best of <br /> my knowledge and belief,true, accurate,and complete. I am aware that there are significant penalties for <br /> submitting false information, including the possibility of fine and imprisonment for knowing violations. <br /> SgIDHAL EN <br /> Bq,- <br /> K. <br /> Jordan Baldwin <br /> Lic#: 71646 r <br /> CA Civil PE <br /> 2769 Boeing Way <br /> Stockton, CA 95206 <br /> s e1V1�- �P <br /> oF ICAL�F04`� <br /> Date stamp/signed: 10/25/19 <br /> Ron's Auto Service Used Motor Oil <br />