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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: 02/25/2020 <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: Mario Lucero ICC Service Tech/Installer Exp. Date: 01/19/2021 <br /> Manufacturer training: NOV, 10/17/21 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> Onsite for the following inspection: <br /> -Witnessed primary piping pressure and soap test of product,vent, and vapor recovery piping and penetrations.All Passed <br /> NOTE: *Additional inspections are needed. Refer to the approval letter for a list of required inspections.* <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: mariano Iucero, Service tech <br /> EH Specialist: SHEWIT WOLDEAREGAY Phone: (209)468-0216 <br /> SR0079417 SC131 02/25/2020 <br /> EHD 23-01 Rev.06/30/15 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />