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S A N J O A Q U ! N Environmental Health Department <br /> C O U N f Y AMPMED <br /> 9/12/2019 <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Address: Date: <br /> Lawrence Livermore National Lab-Site 300 1 15999 W CORRAL HOLLOW RD TRACY August 13 2019 <br /> inspection was completed on 811312019. An inspection report was provided to the facility operator on the day of <br /> inspection The report was amended by the EHD. Violations 106 and 205 were removed. Violation 209 was <br /> amended. The amended report replaces the initial report. <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,within 30 days of receiving the amended inspection report. <br /> Documents provided: <br /> -Return to compliance certification <br /> -Corrective Action Statement <br /> -EHD class schedule <br /> AFTER THE COMPLIANCE DATE,EHD WILL BILL FOR ALL TIME AND ACTIVITIES ASSOCIATED WITH BRINGING THIS <br /> FACILITY BACK INTO COMPLIANCE. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT END'S CURRENT HOURLY RATE. <br /> Received by: Date: Inspector: Inspector Phone: <br /> Printed Name and Title: SHEWIT WOLDEAREGAY, EH Specialist (209)468-0216 <br /> PA0003934 PR0231945 SCO01 Daf13r2019 <br /> EHD 23-01 Rev 08/27/2019 Page 5 of 5 Underground Storage Tank Program OIR <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 I www.sjcehd.com <br />