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SANOAQU I N Environmental Health Department <br /> COU NI T Y I Y Time In: <br /> + _,fr Time Out: <br /> . •- Greotr+ess �row3 here, <br /> Underground Storage Tank Program Service Request Inspection Report <br /> Name of Facility: 7-ELEVEN, INC. Date: 04/04/2022 <br /> Address: 3379 N TRACY BLVD , TRACY 95376 <br /> Requestor: ATTN: GASOLINE COMPLIANCE, 7-ELEVEN INC Telephone: (916)742-0232 <br /> Program Element: 2303-UST/PIPING INSTALLATION Request#: SR0083881 <br /> Inspection Type: 131 -UST INSTALLATION INSPECTION <br /> Onsite Service Technician: Dale Adams ICC Service Tech/Installer Exp. Date: 03/04/2023 <br /> Manufacturer training: Xerxes, 08/01/22 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> On site for the installation of 8,000-gallon/12,000-gallon split tank: <br /> -Received Notice of Completed Work from Xerxes for repair of 8,000-galllon/12,000-gallon split tank <br /> - Inspected repaired section of tank, no leaks observed <br /> -Witnessed tank set of split tank <br /> -Witnessed application of additional corrosion protection on all metal anchor components <br /> -Verified use of manufacturer installation checklist <br /> -Witnessed start of backfill with pea gravel <br /> Note:Additional inspections are required. Please refer to approval letter dated February 4, 2022 for additional inspections <br /> required and additional information. <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: Emailed to Dale Adams, Supervisor <br /> EH Specialist: CAROL PRESTO Phone: (209)616-3061 <br /> SR0083881 SC131 04/04/2022 <br /> EHD 23-01 Rev.09/16/2020 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />