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Time In: <br /> Time Out: <br /> opQ.�tN. San Joaquin County <br /> .X Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �... P Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> �<<FORtN <br /> Underground Storage Tank Program Service Request Inspection Report <br /> Name of Facility: SAFEWAY FUEL CENTER#1769 Date: 07/20/2020 <br /> Address: 2802 COUNTRY CLUB BLVD , STOCKTON 95204 <br /> Requestor: DAN RANSCHER, GRANITE PETROLEUM Telephone: (509)482-7016 <br /> Program Element: 2309-UST RETROFIT-Minor Plan Check Request#: SR0082221 <br /> Inspection Type: 298-UST RETROFIT REPAIR INSPECTION <br /> Onsite Service Technician: Adam Taylor ICC Service Tech/Installer Exp. Date: 12/29/2020 <br /> Manufacturer training: OPW, 04/22/21; Incon, 06/19/22 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> On site for the following: <br /> Spill bucket testing (87 and 91) <br /> -Verified 5 gallon capacity <br /> -Verified drainage <br /> -Witnessed hydrostatic testing for 1 hour. All passed. <br /> 'This facility is not approved to operate or receive fuel until all testing is complete. <br /> To minimize person to person contact EHD is choosing to write the name of person receiving the report instead of having them <br /> sign. <br /> The person in charge is responsible for ensuring that the above mentioned facility is in compliance with all applicable sections of the California Health and <br /> Safety Code.If a reinspection is required,fees will be assessed at the current hourly rate. <br /> Received by: Name and Title: Adam Taylor, Service Technician <br /> EH Specialist: SHEWIT WOLDEAREGAY Phone: (209)468-0216 <br /> FA0012764 SR0082221 SC298 07/20/2020 <br /> EHD 23-01 Rev.06/30/15 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />