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SANOAQU I N Environmental Health Department <br /> COU NI T Y I Y Time In: <br /> + _,fr Time Out: <br /> . •- Greotr+ess �row3 here, <br /> Underground Storage Tank Program Service Request Inspection Report <br /> Name of Facility: San Joaquin General Hospital Date: 10/28/2021 <br /> Address: 500 W Hospital RD , FRENCH CAMP 95231 <br /> Requestor: ANN MARIE OR JOE, BAGLEY ENTERPRISES INC Telephone: (209)367-4800 <br /> Program Element: 2308-UST RETROFIT Request#: SR0084286 <br /> Inspection Type: 298-UST RETROFIT REPAIR INSPECTION <br /> Onsite Service Technician: Bryan Kilby ICC Service Tech/Installer Exp. Date: 08/20/2023 <br /> Manufacturer training: OPW Site Sentinel, 01/09/23 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> On site to verify ball floats are not installed/do not interfere with the drop tube. Cap to the vapor pipe was removed. Ball floats <br /> were not observed. <br /> This facility is approved to receive fuel in the diesel tank. <br /> To minimize person to person contact EHD is choosing to write the name of the person receiving the report instead of having <br /> them sign. <br /> Inspection report emailed to Ann Marie Addler<sales@bagleyenterprises.com>; Escotto, Jesse<jescotto@sjgh.org> <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: Emailed to Jesse Escotto, Facilities M <br /> EH Specialist: CAROL PRESTO Phone: (209)616-3061 <br /> SR0084286 SC298 10/28/2021 <br /> EHD 23-01 Rev.09/16/2020 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />