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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: KWIK SERV LODI BW 113* Date: 03/19/2021 <br /> Address: 420 W KETTLEMAN LN , LODI 95240 <br /> Requestor: BZ MAINTENANCE Telephone: (916)371-2380 <br /> Program Element: 2308-UST RETROFIT Request#: SR0083264 <br /> Inspection Type: 098-UST ONSITE RETROFIT VERIFICATION <br /> Onsite Service Technician: Robert Jacobs ICC Service Tech/Installer Exp. Date: 06/25/2022 <br /> Manufacturer training: OPW, 04/01/21 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> On site for the installation of 71 SO drop tubes for 87, 91 and diesel. <br /> •Verified drop tube calculations at 95% <br /> •The shipped 71 SO-412C for E85 was damaged when shipped. The tube was crooked and the flapper was cracked. E85 drop <br /> tube could not be installed today. <br /> Additional inspection to install E85 drop tube will need to be scheduled.A 48-hour notice is required for inspections. <br /> Facility is not approved to receive fuel in the E85 tank until the new drop tube has been installed. <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: Robert Jacobs, Technician <br /> EH Specialist: CAROL PRESTO Phone: (209)616-3061 <br /> FA0003776 SR0083264 SC098 03/19/2021 <br /> EHD 23-01 Rev.09/16/2020 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />