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Time In: <br /> Time Out: <br /> aR4u!!Y, San Joaquin County <br /> :< <br /> Environmental Health Department <br /> W. <br /> 1868 East Hazelton Avenue, Stockton, CA95205-6232 <br /> • �. ;a• Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> Un erground Storage Tank Program Service Request Inspection Report <br /> Name of Facility: Country Club Valero Date: 04/27/2018 <br /> Address: 2575 COUNTRY CLUB BLVD, STOCKTON 95204 <br /> Requestor: MARK VENDEIRO, CALIFORNIA FUEL SUPPLY Telephone: <br /> Program Element: 2308 - UST RETROFIT Request#: SR0078931 <br /> Inspection Type: 298 - UST RETROFIT REPAIR INSPECTION <br /> Onsite Service Technician: Steven Jones ICC Service Tech/Installer Exp. Date: 07/05/2019 <br /> Manufacturer training: <br /> 0VERALLsINSPECTI0N ®SES AND COMMENTS <br /> .- <br /> NOTES <br /> Conducted visual inspection of the filters within the UDCs and verification of the dispenser footprint contained by the UDCs and <br /> deflectors plates. <br /> This facility is approved to operate. <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: Steven Jones, Installer <br /> EH Specialist: STACY RIVERA Phone: (209) 468-3440 <br /> FAD006439 SR0078931 SC298 04/27/2018 <br /> EHD 23-01 Rev.06/30/15 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />