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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: C-STORE W/76 FUEL ISLAND Date: 07/07/2020 <br /> Address: 141 E HARNEY LN , LODI 95240 <br /> Requestor: MEL HIGGINBOTHAM, PM DESIGN GROUP INC Telephone: (530)303-2814 <br /> Program Element: 2303-UST/PIPING INSTALLATION Request#: SR0079417 <br /> Inspection Type: 131 -UST INSTALLATION INSPECTION <br /> Onsite Service Technician: Steven Jones ICC Service Tech/Installer Exp. Date: 08/05/2021 <br /> Manufacturer training: VR, 07/21/21;VMI, 07/01/20 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> Onsite for a final UST installation inspection. Onsite for a first routine Monitoring System Certification (post-UST installation) <br /> and a routine Underground Storage Tank(UST)inspection.All sensors(liquid, smart)were tested. Leak detectors(87, 91, <br /> diesel)were tested with passing results. <br /> Note: The VMI certification for Steve Jones expired on 7/1/2020. Immediately submit a current VMI certification for Steven <br /> Jones to the EHD. If this certification is not submitted to EHD or the technician does not have the current certification, leak <br /> detector testing will need to be re-conducted by a properly certified technician or EHD staff time associated with a re-inspection <br /> will be billed at a current hourly rate ($152).. <br /> Note: Facility is not authorized to operate until all violations associated with the 7/7/2020 monitoring system certification report, <br /> or any amended versions of that report, are addressed and all requirements for service request SR0079417 are met.Among <br /> the requirements that need to be met are the submission of the California Environmental Reporting System (CERS)and all <br /> applicable hazardous materials, hazardous waste and UST components, an accurate"Certification of Installation/ <br /> Modification"form for each tank shall be submitted into CERS and all outstanding up-to-date permit fees must be paid prior to <br /> receiving the final approval to operate.All submittals must be reviewed and approved by the EHD. <br /> To minimize person to person contact EHD is choosing to write the name of person receiving the report instead of having them <br /> sign. Starting September 1, 2018, all in-office CERS help will be provided at EHD hourly rate($152). To schedule an <br /> appointment, please call (209)4 <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: Steven Jones, Service Technician <br /> EH Specialist: SHEWIT WOLDEAREGAY Phone: (209)468-0216 <br /> SR0079417 SC131 07/07/2020 <br /> EHD 23-01 Rev.06/30/15 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />