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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: ADELFO'S ARCO AM/PM Date: 03/01/2022 <br /> Address: 3443 CHEROKEE RD , STOCKTON 95205 <br /> Requestor: CARRIE MILLER, ELITE IV CONTRACTORS Telephone: (209)461-6337 <br /> Program Element: 2308-UST RETROFIT Request#: SR0084746 <br /> Inspection Type: 298-UST RETROFIT REPAIR INSPECTION <br /> Onsite Service Technician: Adrian Rodriguez ICC Service Tech/Installer Exp. Date: 04/27/2023 <br /> Manufacturer training: OPW, 05/19/23 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> On site for the following inspections: <br /> 1)Overfill prevention equipment verification-87 drop tube: <br /> -Measurement of drop tube, set at less than 95%tank volume, checked tank charts <br /> -Verified flapper functionality <br /> -Verified ball floats, no ball floats installed. <br /> *Please log into CERS and update the overfill prevention equipment options for all tanks. <br /> This facility is approve to receive fuel in the 87 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 mail to: Carl Nahigian, Environmen <br /> EH Specialist: PAUL NSO Phone: (209)616-3049 <br /> FA0024482 SR0084746 SC298 03/01/2022 <br /> EHD 23-01 Rev.09/16/2020 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />