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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: C-STORE W/76 FUEL ISLAND Date: 03/04/2020 <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: Steve Jones/Mario Lucero ICC Service Tech/Installer Exp. Date: 01/23/2021 <br /> Manufacturer training: <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> On site for the following: <br /> -Witnessed one hour secondary containment testing of all pipes(87 product, 91 product, diesel product, 87 vent, 91 vent, <br /> diesel vent,vapor recovery(manifolded), chase between diesel sumps, chase between 87 sumps)and sumps(6 UDCs, diesel <br /> STP, 87 STP, 91 STP, diesel fill, 87 fill, 91 fill,vent sump). All passed. <br /> -Witnessed soap testing of all pipes. No leaks observed. <br /> "Additional inspections needed. See approval letter dated 12/5/20. <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: Steve Jones, Installer <br /> EH Specialist: STACY RIVERA Phone: (209)468-3440 <br /> SR0079417 SC131 03/04/2020 <br /> EHD 23-01 Rev.06/30/15 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />