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Environmental Health Department <br />Hazardous Materials Program Inspection Report <br />Date: <br />July 28, 2021 <br /> Facility Address: <br /> 444 W MOSSDALE RD, LATHROP <br /> Facility Name: <br /> Mossdale Chevron <br />Conducted a Hazardous Materials Business Plan (HMBP) inspection. There were three violation(s) during the <br />inspection. Complete and submit a copy of the Return to Compliance Certification form to the EHD with a <br />statement documenting the corrective actions that have been or will be taken for each violation, and any <br />supporting paperwork, by 09/19/2921. <br />To minimize person to person contact EHD is choosing to write the name of person receiving the report instead <br />of having them sign. Starting September 1, 2018, all in-office CERS help will be provided at EHD hourly rate <br />($152). To schedule an appointment, please call (209) 468-3420. <br />Documents provided: Inspection report, corrective action statement form and a list of approve free CUPA <br />training classes. <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: Inspector Phone: <br /> PAUL NSO, EH Specialist <br /> Inspector:August 20, 2021 Date: <br />Printed Name and Title: <br />E mailed to:paldhaliwal@msn.com, Owner <br />(209) 616-3049 <br />FA0000212 PR0520915 SC001 07/28/2021 <br />EHD 19-01 Rev. 9/16/2020 Hazardous Materials Program OIRPage 3 of 3 <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/EHD