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SAN J O A Q U I N Environmental Health Department <br /> —COUNTY— Time In: <br /> Time Out: <br /> i�C1FaR'' GreQl tress grows her— <br /> Underground <br /> ey—Underground Storage Tank Program Service Request Inspection Report <br /> Name of Facility: 7-ELEVEN INC#38616 Date: 06/09/2021 <br /> Address: 601 W CAROLYN WESTON BLVD , STOCKTON 95206 <br /> Requestor: ROBERT FORLOINE, PM DESIGN GROUP INC Telephone: (707)387-9883 <br /> Program Element: 2303-UST/PIPING INSTALLATION Request#: SR0082546 <br /> Inspection Type: 131 -UST INSTALLATION INSPECTION <br /> Onsite Service Technician: Tom Sanford ICC Service Tech/Installer Exp. Date: 09/25/2022 <br /> Manufacturer training: Xerxes, 01/22/22 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> On-site to witness the installation of the following underground storage tanks: <br /> - 1 Xerxes 20,000 gallon tank <br /> - 1 Xerxes 12,000 gallon primary tank <br /> - 1 Xerxes 8,000 gallon end tank <br /> While on-site the following items were verified: <br /> -Manufacturer and capacity of tanks are consistent with permit plans <br /> -Tanks had UL labels <br /> -No brine leaks were observed outside the tanks <br /> -Per ICC installer Tom Sanford, no brine leaks were observed inside the tanks <br /> -The tank installation checklist was on site and completed during the installation <br /> -Anchorage and the use of deadmen <br /> -Application of additional corrosion protection to all exposed metal <br /> -Appropriate backfill <br /> -Compaction/probing of backfill <br /> -Tank orientation matches approved plans <br /> This site requires additional testing. Refer to the permit approval letter for the required inspections and provide a 48-hour <br /> notice by emailing ust@sjgov.org. <br /> Provide additional documentation from the tank manufacturer regarding the acceptable testing procedures for ballasted tank <br /> installations. <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 /> 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: Emailed to Crystal Justice, Construct <br /> EH Specialist: VICKY VANG-LEE Phone: (209)616-3028 <br /> SR0082546 SC131 06/09/2021 <br /> EHD 23-01 Rev.09/16/2020 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />