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Time In: <br /> Time Out: <br /> opQ.�tN. San Joaquin County <br /> .X Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �... P Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> �<<FORtN <br /> Underground Storage Tank Program Service Request Inspection Report <br /> Name of Facility: COUNTRY MARKETPLACE Date: 06/20/2019 <br /> Address: 1789 W CHARTER WAY, STOCKTON 95206 <br /> Requestor: MEGAN MITCHELL, ELITE IV CONTRACTORS Telephone: (209)461-6337 <br /> Program Element: 2308-UST RETROFIT Request#: SR0080132 <br /> Inspection Type: 298-UST RETROFIT REPAIR INSPECTION <br /> Onsite Service Technician: Frederick C. Babel ICC Service Tech/Installer Exp. Date: 05/20/2021 <br /> Manufacturer training: VR, 01/20/20; Bravo, 04/02/22 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> On site for the following inspections: <br /> -Verified dispenser footprint and all piping is contained within the under dispenser containment sumps(UDCs). <br /> -Visually inspected the piping under the dispensers. No leaks observed. <br /> -Verified installation of Bravo conversion frames and deflector plates on all dispensers. <br /> -Verified sensor functionality. <br /> -Received an alarm history and set up from prior to the cold start(6/20/2019 at 1:16 PM)and a set up for after the cold start <br /> (6/20/19 at 2:31 PM). <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: Frederick Babel, Service Technician <br /> EH Specialist: SHEWIT WOLDEAREGAY Phone: (209)468-0216 <br /> FA0007486 SR0080132 SC298 06/20/2019 <br /> EHD 23-01 Rev.06/30/15 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />