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Time In <br /> lime Out <br /> ray "'" San Joaquin County <br /> y Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, CA95205-6232 <br /> . Telephone.(209)468-3420 Fax:(209)4640138 Web:www.siaov.oral hd <br /> Underground Storage Tank Program Service Request Inspection Report <br /> Name of Facility: <br /> Date: <br /> Address: <br /> Requestor: Telephona <br /> Program Element: Request#: <br /> Inspection Type' <br /> Onsite Service Technician ICC Service Tech'Installer Exp. Date: <br /> Manufacturer training: <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> N QTES <br /> MAR 02 2016 <br /> ENWHONMENTAL <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: <br /> FAD003635 SR0073997 SC298 02/022016 <br /> EHD 23-01 Rev.MNY15 Page 1 of 11 Underground Storage Tank Program Smice Rewesi Inspection Report <br />