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r: � I I I Environmental Health Department <br /> Y SA N U <br /> rk.1 wti COUNTY Time In: <br /> Time Out: <br /> Greorness grows here, <br /> Underground Storage Tank Program Service Request Inspection Report <br /> Name of Facility: CITY GAS&LIQUOR Date: 12/09/2021 <br /> Address: 16470 CAMBRIDGE ST , LATHROP 95330 <br /> Requestor: DEBORAH JONES, ELITE IV CONTRACTORS Telephone: (209)461-6337 <br /> Program Element: 2308-UST RETROFIT Request#: SR0084492 <br /> Inspection Type: 298-UST RETROFIT REPAIR INSPECTION <br /> Onsite Service Technician: Michael Kennard ICC Service Tech/Installer Exp. Date: 07/06/2023 <br /> Manufacturer training: OPW, 05/19/23 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> On site for the following inspection on 91 tank: <br /> Overfill prevention equipment verification: OPW drop tube. <br /> -Overfill prevention drop tube measurement set at 94%tank volume shut off <br /> -Verified flapper functionality <br /> -Verified ball floats. Ball floats not installed. <br /> This facility is approve to receive fuel in the 91 tank. <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 to:Amarjit Khinda, Environm <br /> EH Specialist: PAUL NSO Phone: (209)616-3049 <br /> FA0000185 SR0084492 SC298 12/09/2021 <br /> EHD 23-01 Rev.09/16/2020 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />