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Time In: <br /> Time Out: <br /> �P.�•ut�!. c San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, CA95205-6232 <br /> • c... :P• Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> ���FORN <br /> Underground Storage Tank Program Service Request Inspection Report <br /> Name of Facility: BILLS 76 Date: 03/15/2019 <br /> Address: 633 E VICTOR RD , LODI 95240 <br /> Requestor: MEGAN MITCHELL, ELITE IV CONTRACTORS Telephone: (209) 641-6337 <br /> Program Element: 2308- UST RETROFIT Request#: SR0080013 <br /> Inspection Type: 298- UST RETROFIT REPAIR INSPECTION <br /> Onsite Service Technician: Chris Adams ICC Service Tech/Installer Exp. Date: 04/19/2020 <br /> Manufacturer training: Veeder-Root, 09/27/19 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> On site for inspection after dispenser replacement and cold start of the monitoring panel. <br /> -Visual inspection of the piping under the dispensers. No leaks observed. <br /> -Verified proper location of floats and sensors in UDCs. <br /> -Verified dispenser footprint and all piping is contained within UDCs. No conversion frames or deflector plates are needed. <br /> -Verified functionality of the positive shutdown for all three grades(87, 89, 91). <br /> -Received an alarm history and set up from prior to the cold start(3/15/19 at 7:41 AM)and a set up for after the cold start <br /> (3/15/19 at 11:01 AM). <br /> -Verified sensor functionality testing is being conducted by the technician on site, but testing was not witnessed. <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: Chris Adams, service tech <br /> EH Specialist: STACY RIVERA Phone: (209)468-3440 <br /> FA0000483 SR0080013 SC298 03/15/2019 <br /> EHD 23-01 Rev.06/30/15 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />