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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: 03/09/2020 <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 ICC Service Tech/Installer Exp. Date: 01/25/2021 <br /> Manufacturer training: <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> On site for the following: <br /> -Verified proper brine manufacturer. <br /> -Verified brine filling was conducted in accordance with manufacturer instructions. Witnessed the addition of brine on all UDCs <br /> and sumps. <br /> -Verified slope of all piping at 1/8 inch per foot to containment sumps. <br /> -Verified piping setbacks, burial depths, and crossover distances. <br /> *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 /> IZ <br /> 9— <br /> Received by: Name and Title: Steven Jones, Installer <br /> EH Specialist: SHEWIT WOLDEAREGAY Phone: (209)468-0216 <br /> SR0079417 SC131 03/09/2020 <br /> EHD 23-01 Rev.06/30/15 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />