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SAN J O A Q U I N Environmental Health Department <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name : Facility Address: Date: <br /> Other Violations <br /> 2010 See below Unlisted General violation ❑ V ❑ R ❑ COS <br /> SUMMARY OF VIOLATIONS <br /> (CLASS I, CLASS ll, or MINOR - Notice to Comply) <br /> Item # Remarks <br /> Overall Inspection Comments : <br /> An inspection checklist was provided to the facility operator at the time of inspection . The inspector will provide a complete report to the facility <br /> operator within the next few weeks . <br /> Complete and submit a copy of the Return to Compliance Certification form to the EHD with a statement documenting the corrective actions that <br /> have been or will be taken for each violation , and any supporting paperwork, within 30 days of receiving the complete inspection report. <br /> To minimize person to person contact EHD is choosing to write the name of person receiving the report instead of having them sign . Starting <br /> September 1 , 2018, all in-office CERS help will be provided at EHD hourly rate ($ 152 ) . To schedule an appointment, please call (209) 468-3420 . <br /> AFTER THE COMPLIANCE DATE , EHD WILL BILL FOR ALL TIME AND ACTIVITIES ASSOCIATED WITH BRINGING <br /> THIS FACILITY BACK INTO COMPLIANCE. <br /> TFAS FjqCILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE . <br /> e erved b6o <br /> Date: ('j � � , Inspector: Inspector Phone: <br /> Shewit woldearegay 209-616-3063 <br /> lPrinted Name Title: <br /> \0% <br /> Page 4 of 4 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. sjgov. org/EHD <br />