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SAN JOAHI Environmental Health Department <br /> C U NTY Time In: <br /> Time Out: <br /> ' SS grows hojr <br /> Underground Storage Tank Program Service Request Inspection Report <br /> Name of Facility: C-STORE W/76 FUEL ISLAND Date: 08/18/2020 <br /> Address: 141 E HARNEY LN , LODI 95240 <br /> Requestor: MEL HIGGINBOTHAM, PM DESIGH 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: 08/05/2021 <br /> Manufacturer training: VMI, 07/26/22 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> On site for the following inspection: <br /> Witnessed product line leak detector test for 87, 91 and diesel. <br /> All passed. <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. <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 /> 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: Mark Vendeiro, Project Manager <br /> EH Specialist: PAUL NSO Phone: (209)468-3432 <br /> SR0079417 SC131 08/18/2020 <br /> EHD 23-01 Rev.06/30/15 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />