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S A N J Q Q Q U IN Environmental Health Department <br /> COUNTY <br /> Greorness grows here. <br /> Underground Storage Tank Program Service Request Inspection Report <br /> Name of Facility: WINE COUNTRY STATION/7-ELEVEN Date: 10/05/2023 <br /> Address: 1111 E KETTLEMAN LN , LODI 95240 <br /> Requestor: CARRIE MILLER, ELITE IV CONTRACTORS Telephone: (209)461-6337 <br /> Program Element: 2308-UST RETROFIT Request#: SR0087100 <br /> Inspection Type: 298-UST SERVICE REQUEST- FIELD ACTIVITY <br /> Onsite Service Technician: Adrian Rodriguez ICC Service Tech/Installer Exp. Date: 08/10/2025 <br /> Manufacturer training: Modern Welding, 03/09/24; OPW, 07/12/25 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> Witnessed the following testing: <br /> 1. Spill container(diesel) <br /> -1 hour hydrostatic test <br /> -verified 5 gallon capacity <br /> -verified proper drainage <br /> 2. Secondary containment testing on diesel tank <br /> -1 hour pressure test <br /> All components tested passed. <br /> Submit test results to the Environmental Health Department within 30 days of the test date by emailing ust@sjgov.org. <br /> To minimize person to person contact the EHD is choosing to write the name of person receiving the report instead of having <br /> them sign. Starting September 1, 2018, all in-office CERS help will be provided at EHD hourly rate($162).To schedule an <br /> appointment, please call (209)468-3420. <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 Carrie Miller, Contractor O <br /> EH Specialist: VICKY VANG-LEE Phone: (209)616-3028 <br /> FA0007594 SR0087100 SC298 10/05/2023 <br /> EHD 23-01 Rev.07/05/2022 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />