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i �� I I I AI Environmental Health Department <br /> YSA N U N <br /> rT�z wti COUNTY Time In: <br /> Time Out: <br /> Greotr+ess �rGws here, <br /> Underground Storage Tank Program Service Request Inspection Report <br /> Name of Facility: A&A GAS FOOD MART Date: 11/17/2021 <br /> Address: 1330 E YOSEMITE AVE , MANTECA 95336 <br /> Requestor: EMILY CRAIN, BZ MAINTENANCE Telephone: (916)371-2380 <br /> Program Element: 2308-UST RETROFIT Request#: SR0082633 <br /> Inspection Type: 298-UST RETROFIT REPAIR INSPECTION <br /> Onsite Service Technician: Rhome Desbiens ICC Service Tech/Installer Exp. Date: 12/10/2022 <br /> Manufacturer training: EMCO, 01/21/23 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> On site for the following inspections on 87 and 91 tanks: <br /> Overfill prevention equipment Verification: <br /> -Measurement of EMCO A1100 drop tubes set at 94%tank volume. <br /> -The OPV assembly-done in the shop <br /> -Verified ball floats. Ball floats installed. Installed ball floats removed by Service technician. <br /> This facility is approve to receive fuel in the 87 and 91 tanks. <br /> Please log into CERS and update the 87 and 91 tank information. <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: E mailed report to: Ghulami Ali, Oper <br /> EH Specialist: PAUL NSO Phone: (209)616-3049 <br /> FA0012355 SR0082633 SC298 11/17/2021 <br /> EHD 23-01 Rev.09/16/2020 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />