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Time <br /> Time Out a�4!!!k, 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 /> ��fFOR� <br /> Underground Storage Tank Program Service Request Inspection Report <br /> Name of Facility: LODI MEMORIAL HOSPITAL Date: 08/16/2016 <br /> Address: 975 S FAIRMONT AVE, LODI 95240 <br /> Requestor: Telephone (209)461-6337 <br /> Program Element: 2308- UST RETROFIT Request#: SR0074655 <br /> Inspection Type: 298- UST RETROFIT REPAIR INSPECTION <br /> Onsite Service Technician Frederick Babel ICC Service Tech/Installer Exp. Date: 02/20/2017 <br /> Manufacturer training: Veeder Root, 10/01/16 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTE <br /> On Site to witness the functionality test for the monitoring system and overfill prevention after the cold start. All passed. All <br /> functions normal verified before leaving the site. <br /> The person in charge is responsible for ensuring that the above mentioned facility is in compliance with all app' le sections of the California Health and <br /> Safety Code.If a reinspection is required,fees will be assess at the cur, nt hourly rate. <br /> Received by: Name and Title. - -C <br /> EH Specialist: RIS VEL((SO Phone: 209 4t8453 <br /> FA0000513 SR0074655 SC298 08/16/2016 <br /> EHD 2301 Rev.06/30/15 Page 1 of 1 Vund Storage Tank Program Service Request Inspection Report <br />