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r r erg ; -�; c. c& <br /> Agency Inspection Report Cover Sheet <br /> ( Scan and email ALL Agency Inspection Reports with or without corrective actions ) <br /> DATE : �7 � a C) 1 00000�oPages . <br /> ( Including cover) <br /> TPermit Desk --- Permitesk@chevron . com <br /> Scan and email Agency Inspection Report to the Permit Desk <br /> If no scanning capability , Fax to : ( 925 ) 842 -9585 or (925 ) 842 -5660 <br /> F tation # 208117 / 1718 000000000 <br /> ( Chevron Facility ) / ( CSI # ) <br /> Phone umber : 209 - 830- 0370 <br /> Print Manager Names Kristina Ramirez <br /> My facility received the attached ( check appropriately below ) : <br /> ❑ NOV - Notice of Violation : A document issued by a Government or Local Agency identifying <br /> a violation or condition that requires a corrective action by a specified date and required payment of a <br /> monetary fine or penalty . <br /> ANTC soNotice to Comply : A document issued by a Government or Local Agency identifying a <br /> violation or condition of non -compliance that requires a corrective action by a specific date but does <br /> not levy a monetary fine or penalty . <br /> ❑ Other . 100 % or Any Government or Local Agency document or communication (these <br /> include a successfully passed inspection ) <br /> Name of BC . Diane Province <br /> Name of Retail OE/ HES Specialist : Gerardo Acuna <br /> Comments : <br /> In addition to submitting a legible inspection report , please place report into the Retail <br /> Facility Compliance Workbook under Section 9 " RFC Inspections " . <br /> AGENCY INSPECTION REPORT COVER SHEET - V217/16/2015 <br /> DOCUMENT OWNER : OE/HES PERMIT DESK <br />