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Time In: <br /> Time Out: <br /> P'�urN San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, CA95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> 9�%FORM <br /> Underground Storage Tank Program Service Request Inspection Report <br /> Name of Facility: iAH((J UoUoU Date: j2102/201t_, <br /> Address: S E LOUISE AVE. LATHROP 95330 <br /> Requestor: Telephone <br /> Program Element: 2308- UST RETROFIT Request#: nn7^.nn7 <br /> Inspection Type: 298 ! !CT ""c"" "EPAIR INSPECTIO <br /> Onsite Service Technician .un i In-i Attains ICC Service TecKlnstaller Exp. Date: 5/26/2017 <br /> Manufacturer training: Veeder Root,08/03/17 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> -)n site to witness the testing of the 87 and diesel/91 tanks annular sensors. Veeder Root 794380-303 sensors were installed <br /> with the following serial numbers. <br /> 87 tank: 1525 <br /> 91/diesel tank: 1537 <br /> Functionality tests for low liquid, high liquid, sensor out, and power out were verified. <br /> Positive shutdown was also verified. <br /> All pass. <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 r fired,fees will be assessed at the current hourly rate. <br /> Received by: <br /> S/-2-// LV Name and Title: k OS IQ <br /> EH Specialist: ARIS VELOSO Phone: (209)468-3453 <br /> FA0003635 SR0073997 SC298 02/02/2016 <br /> EHD 23-01 Rev.06130/15 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />