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pully <br /> SAN _ Q AQ Q N Environmental Health Department <br /> COU NTY— <br /> o �lr Greatness prows here. <br /> OFFICIAL INSPECTION REPORT <br /> FACILITY NAME/TYPE: Flying J Travel Plaza #617 DATE:3/10/23 <br /> ADDRESS: 15237 N. Thornton Rd. CITY:Lodi ZIP CODE:95242 <br /> OWNER/OPERATOR: TELEPHONE#: <br /> TYPE OF INSPECTION: ❑ COMPLAINT ❑ CONSULTATION W OTHER PROGRAM 2361 RECORD PR0517272 <br /> ELEMENT: ID#: <br /> NATURE OF COMPLAINT/CONSULTATION: <br /> On site for SR0086110 inspection. <br /> OBSERVATIONS/COMMENTS: <br /> Witnessed secondary containment testing of UDCs 1/2 and 5/6. Both passed. <br /> Tester: Keith Henderson <br /> ICC 4/1/23 <br /> Incon 7/10/23 <br /> CORRECTIVE ACTIONS: <br /> The service company must provide the following documentation to the tank owner/operator for an inspector to review <br /> during the annual UST inspection: <br /> a. Description of part(s) installed (parts list, cut sheets, etc.) <br /> b. Name & UST ICC#of the service technician performing the work (ICC, manufacturer certification proof, etc.) <br /> c. Testing documentation to verify installation and functionality of the repair <br /> Submit test results to ust@sjgov.org within 30 days of testing. <br /> CORRECT BY: -- <br /> INSPECTED BY:Stacy Rivera (209)616-3043 <br /> RECEIVED BY: Emailed to Rob Sills and Joey Cupp DATE:3/10/23 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> EHD48-05 Rev.05/21/18 INSPECTION REPORT <br />