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5 <br />0 San Joaquin County 0 <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA95205-6232 <br />�-C&LIFL­17LP lie <br />ffiatUa i��IJVNJ <br />Time In: <br />Time Out: <br />Name of Facility: QUW, E>TOP rviARKEIF #"3" 148' <br />Address: ST '..D D. 9524,") <br />Requestor: & <br />925 6 -9210"0 <br />Telephonec .67 <br />Program Element: Z­2'��')8 <br />Request #: R 0 01774;,:� 07 <br />C H, <br />Inspection Type: 19,,'� - RER"'IR PLA' ' H'EE'Cr,'� <br />OnsiteServiceTechnician: <br />[CC Service TechInstaller Exp. Date: OE00,11''­1 '7 <br />Manufacturer training: <br />OVERALL INSPECTION NOTESAND COMMENTS <br />NOTE <br />On siih"­ to f I il e M ml,�zing, <br />If' J "NO `.-'q <br />-My lh-i' pi -q-, i#-, r, cp""c�:: �:J 1"he d- -A f,'� j)r S b�nqj­ V-1 <br />plet ed I o vei <br />.. ...i -�spc ;'i. <br />The <br />U I h <br />0 bsV, <br />Jhaim' ei� _,c <br />The person in charge is responsible for ensuring that the above mentioned facility is in compliance with all aDDliCabile sections oVIxe California Health and <br />Safety Code. If a reinspection is required, fees will be assessed at the current hourly rate. <br />L <Su k yc� <br />Received by: Q22�-S,11ame and Title: <br />P <br />EH Specialist: _ARiS VELOS hone: (2091468 34 5> <br />FA0000670 SR0074607 SC198 07/14/2016 <br />EHD 23-01 Rev. 06130V15 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />