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Time In: <br />San Joaquin County 40 Time Out: <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA95205-6232 <br />Telephone. (209) 468-3420 Fax: (209) 464-0138 Web. www.sigov.orateh <br />Name ofFacility. <br />Date: 8. <br />V\,� T'L� -T 1,( 9 <br />Address: IJ Q 3 "Y <br />Requestor: <br />T lephonet <br />Program Element: �,--R'E7 PC Fi 7 <br />Request #. <br />Inspection Type: 9 0 -,1 1 PEI,w'C T, R V 1 C E 1, B P�j' -2, 1 <br />Onsite Service Technician <br />ICC Service recfflnstaller Exp. Date: <br />Manufacturer training. S, -,VII' ,, -V'D 4 16: V fi fD e <br />OVERALL INSPECTION NOTES AND COMMENTS <br />NOTE <br />d <br />s , d -,i f �f,'J 1 -f r, I e', f 4,1 i e S! S vf, j o b 1_. a, i e d d p e f <br />mser conta <br />fc�r one <br />S,24cavu, <br />A,Hf bef, <br />v�lhre-n inll <br />fi,to _ �- c pip�, - I P-- CII, <br />-� lw.H <br />ID 48 h 1 <br />co,-- — j-rto 'he r (-,- <br />Y,' rek,--p.tested inspec,6on. <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: <br />EH Specialist: 1`0 V <br />Name and Title: <br />FA0004547 SR0073163 SC975 0118/2016 <br />EHD 2"1 Rev. 06MI 5 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />