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Time In: <br /> San Joaquin County time Out: <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, CA95205-6232 <br /> 4 Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov ordehd <br /> C/Fdlrlr <br /> Underground Storage Tank Program Service Request Inspection Report <br /> Name of Facility: / PACIFIC LODI PLANT K :DLOCK Date: <br /> Address: VICTOR RD, LODI 95240 <br /> Requestor. ',E ELLASON,VALLEY P! ' `ROLEUI.' Telephone <br /> Program Element: X308- UST` TROF Request* SKUCr 4101 <br /> Inspection Type: I i icT r '_IT _'-TIC <br /> Onsite Service Technician ICC Service Tech/nstaller Exp. Date: <br /> Manufacturer training: '?ravo StIf <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> , witness the secondary containment test and piping soap test pre-backfill. (northern tank piping) <br /> The product piping secondary containment held 5 psi for one hour. No bubbles observed during the soap test. <br /> Ok to backfill. <br /> An inspection has been scheduled tomorrow at 1 PM for the following: <br /> 1. The product piping secondary containment test post backfill after the concrete has cured. (northern and southern tank <br /> secondary piping due to concrete being broken above each) <br /> 2. Leak detector test to verify it can pass the 3 gal./hr at 10 psi test. <br /> 3. Visual inspection inside the UDCs to verify that no leaks occur while fuel is being pumped. <br /> Secondary containment testing on the repaired 87 product secondary piping is required six months after installation. Provide <br /> 48 hours notification to the EHD when this test is scheduled.Log into the California Environmental Reporting System(CERS), <br /> update as necessary and submit the"UST Monitoring Plan'"for the 87 tank for approval. <br /> Log into the California Environmental Reporting System(CERS), complete and submit a"UST Certification of <br /> installation/Modification"form for the repaired 87 product secondary containment pipe within 30 days. <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 Name and Tit / /moi ° L-1 C's <br /> ---�� <br /> EH Specialist: ';RIS VELOSO Phone: <br /> FA0005584 SR0074101 SC298 02/042016 <br /> EH132301 Rev,M30/15 Page 1 of 1 Underground Storage Tank Progrem 5.rv"Request Inspection Report <br />