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ur I Environmental Health Department <br />41 t: SAN-6-JOAQU <br />vii fir: C (--) LJ Y Time In: <br />r <br />Time Out: <br />r'�JFOSX:, Careotness grows here. <br />Underground Storage Tank Program Service Request Inspection Report <br />Name of Facility: Supervalu <br />Date: 08/16/2022 <br />Address: 1990 N PICCOLI RD, STOCKTON 95215 <br />Requestor: CARRIE MILLER, ELITE IV CONTRACTORS <br />Telephone: (209) 461-6337 <br />Program Element: 2308 - UST RETROFIT <br />Request #: SR0085482 <br />Inspection Type: 298 - UST RETROFIT REPAIR INSPECTION <br />Onsite Service Technician: Adrian Rodriguez <br />ICC Service Tech/Installer Exp. Date: 04/27/2023 <br />Manufacturer training: OPW, 05/19/23 <br />OVERALL INSPECTION NOTES AND COMMENTS <br />NOTES <br />On site for inspection of new diesel overfill flapper. <br />-Verified flapper functionality. <br />-Verified overfill prevention is set at or below 95%, using tank charts. <br />The facility is approved to receive fuel in the diesel tank. <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: STACY RIVERA <br />Name and Title: <br />Phone: <br />FA0003826 SR0085482 SC298 08/16/2022 <br />EHD 23-01 Rev. 06/30/15 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />