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Underground Storage Tank Program Service Request Inspection Report <br />Facility Name and Address: San Joaquin County Public Health Services, 1601 E HAZELTON AVE , STOCKTON 95205 <br />Environmental Health Department <br />2) UST tracking Record Sheet and/or Tank and Piping Hazardous Waste Manifest Tank Closure Certification Form <br />(DTSCForm 1249) <br />3) Hazardous Waste Manifest for rinsate and residual product, disposal records for piping, spill containers and sumps. <br />4) Backfill Excavation Certification <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: <br />EH Specialist:Phone:(209) 616-3063 <br />Emailed report to Rob Barber, Contra <br />SHEWIT WOLDEAREGAY <br />Page 2 of 2EHD 23-01 Rev. 07/05/2022 Underground Storage Tank Program Service Request Inspection Report <br />FA0001696 SR0086989 SC298 07/31/2023