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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#41216 Date: 01/25/2021 <br /> Address: 770 W CHARTER WAY, STOCKTON 95206 <br /> Requestor: CRYSTAL JUSTICE-CONSTRUCTION MANAGER, 7-ELEVEN INC Telephone: (916)742-0232 <br /> Program Element: 2303-UST/PIPING INSTALLATION Request#: SR0082094 <br /> Inspection Type: 131 -UST INSTALLATION INSPECTION <br /> Onsite Service Technician: Dale Adams ICC Service Tech/Installer Exp. Date: 03/13/2021 <br /> Manufacturer training: Xerxes, 08/01/22 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> On site to witness installation of 3 underground storage tanks: <br /> -one 20 thousand gallon Xerxes tank <br /> -one 12 thousand gallon Xerxes tank(base tank of a 20 thousand gallon split tank) <br /> -one 8 thousand gallon Xerxes tank(end tank of a 20 thousand gallon split tank) <br /> Inspected tanks prior to installation <br /> -inspected tanks for evidence of brine leaks. No leaks were observed. <br /> -verified UL labeling on all tanks <br /> -interior of tanks were inspected by the ICC installer on site who stated tanks were clean and brine-free <br /> -verified the use of the manufacturer's installation checklist at the time of the inspection <br /> -per manufacturer's instructions, measurements are to be taken of brine reservoir and tank diameter prior to installation, <br /> however, contractor Dale Adams states measurements will be taken once tanks have been set and stabilized in the pit as a <br /> safety precaution. <br /> Other observations during inspection: <br /> -verified presence of deadman and use of anchor straps <br /> -witnessed tank set <br /> -verified the use of appropriate backfill <br /> -verified application of additional corrosion protection on tank anchors and all exposed metal <br /> -witnessed backfilling of the tank pit and probing of pea gravel <br /> To minimize person to person contact EHD is choosing to write the name of person receiving the report instead <br /> of having them sign. Starting September 1, 2018, all in-office CERS help will be provided at EHD hourly rate <br /> ($152).To schedule an appointment, please call (209)468-3420. <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: Dale Adams, Contractor <br /> EH Specialist: VICKY VANG-LEE Phone: (209)616-3028 <br /> SR0082094 SC131 01/25/2021 <br /> EHD 23-01 Rev.09/16/2020 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />