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Environmental Health Department <br /> SALMON <br /> ; ) Time In: <br /> e ;� COUNTY" <br /> 1 r 41a <br /> TimeOul <br /> �irt,41A $is grow;li #r <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 /> 00010 <br /> Onsite Service Technician: Rhome Desbiens ICC Service Tech/installer Exp, Date: 12/10/2022 <br /> Manufacturer training : EMCO, 01 /21 /23 <br /> rt <br /> sss WIN <br /> Z r� _ r� <br /> �.. ��F.}l - .Y��tv �t. _, --s .t.,. a .`i <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 .wdte the name of person receiving the report instead of having them <br /> sign. <br /> I <br /> I <br /> I <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 /> i <br /> i <br /> Received by: Name and Title: E mailed report to: Ghulami All, Oper <br /> I <br /> EH Specialist: PAUL NSO Phone: (209) 616-3049 <br /> FA0012355 SR0082633 SC208 11/172021 <br /> EHD 23-01 Ray. 091182020 Page 1 of 1 Underground Storage Tank Program Servloa Request Inspection Report <br />