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S A J OAQ U I Environmental Health Department <br /> �. 0U N TY— <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Address: Date: <br /> KISHIDA, GEORGE INC 1725 ACKERMAN DR, LODI November 15, 2019 <br /> appointment, please call (209) 468-3420. <br /> The following was observed during this inspection: <br /> - Fuel filter for dispenser#1 was located not to allow drips or leaks to the UDC. <br /> list of documents reviewed. <br /> - Financial responsibility forms <br /> - Alarm History <br /> -Facility operating forms <br /> -Response plan <br /> -Monitoring plan <br /> -Monitoring site plan <br /> -Designated operator statement and compliance statement <br /> -Employee training form <br /> The following was provided during this inspection: Schedule of free CUPA classes, Return to Compliance <br /> Certification Form and Corrective action statement form. <br /> AFTER THE COMPLIANCE DATE, EHD WILL BILL FOR ALL TIME AND ACTIVITIES ASSOCIATED WITH BRINGING <br /> THIS FACILITY BACK INTO COMPLIANCE. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE <br /> Received by: Date: November 15, 2019 Inspector: Inspector Phone: <br /> Printed Name and Title: PAUL NSO, EHS Trainee (209)468-3432 <br /> Kelli Kishida, Secretary Treasury <br /> FA0003756 PR0231309 SCO01 11/15/2019 <br /> EHD 23-01 Rev.9/20/2019 Page 6 of 6 Underground Storage Tank Program OIR <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />