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SANJUAQUIN Environmental Health Department <br />—COUNTY Time In: <br />Time Out: <br />ilGreorness grows here. <br />Underground Storage Tank Program Service Request Inspection Report <br />Name of Facility: QUIK STOP MARKET #551121 <br />Date: 09/29/2021 <br />Address: 1196 W LOUISE AVE, MANTECA 95336 <br />Requestor: DEBORAH JONES, ELITE IV CONTRACTORS <br />Telephone: (209) 641-6337 <br />Program Element: 2308 - UST RETROFIT <br />Request #: SR0083606 <br />Inspection Type: 298 - UST RETROFIT REPAIR INSPECTION <br />Onsite Service Technician: Chris Adams <br />ICC Service Tech/Installer Exp. Date: 09/08/2023 <br />Manufacturer training: VR, 10/08/21; Bravo, 04/02/22 <br />OVERALL INSPECTION NOTES AND COMMENTS <br />NOTES <br />On site for the following inspections: <br />- Verified dispensers footprints contained by the under dispenser containment sumps(UDCs), deflector plates installed and fuel <br />filters drain into UDCs <br />- Visual inspection of the piping within the dispensers <br />- Verified sensors functionality, received copy of alarm history before cold start and monitoring system restored to normal <br />- Verified conversion frames installed. <br />All passed <br />This facility is approve to operate the UST system. <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: <br />EH Specialist: PAUL NSO <br />Name and Title: Emailed report to: Marty Hilfinger, En <br />Phone: (209) 616-3049 <br />FA0000848 SR0083606 SC298 09/29/2021 <br />EHD 23-01 Rev. 09/16/2020 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />