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SANJOAQUI Environmental Health Department <br />f Crectness grows Frere, <br />Underground Storage Tank Program Service Request Inspection Report <br />Name of Facility: FAST N EASY MART #104 <br />Date: 04/05/2023 <br />Address: 16460 GOLDEN VALLEY PKWY, LATHROP 95330 <br />Requestor: MUHAMMAD BILAL, RIVER ISLAND CHEVRON <br />Telephone: (707) 486-8894 <br />Program Element: 2303 - UST/PIPING INSTALLATION <br />Request #: SR0086111 <br />Inspection Type: 298 - UST RETROFIT REPAIR INSPECTION <br />Onsite Service Technician: Adolf Alves Scot <br />ICC Service Tech/Installer Exp. Date: 12/02/2024 <br />Manufacturer training: CSI, 07/23/24 <br />OVERALL INSPECTION NOTES AND COMMENTS <br />NOTES <br />On site for the installation of new USTs <br />-20,000 gallon Containment solutions (CSI) double -walled fiberglass tank <br />-10,000 gallon / 10,000 gallon Containment solutions (CSI) double -walled fiberglass split tank <br />-10,000 gallon / 10,000 gallon Containment solutions (CSI) double -walled fiberglass split tank <br />-Verified UL labeling on all tanks. <br />-Inspected tanks for brine leaks. No leaks observed on all tanks. <br />-Inside of tank was inspected by the contractor on site(Adolf Scot) and stated to be clean and brine -free. <br />-Verified the use of the manufacturer installation checklist at the time of inspection. <br />-Verified tank pit, 10 feet deep with little water and 1.5f eet pea gravel at the bottom <br />-Verified presence of deadmen and use of anchor straps. <br />-Verified the application of additional corrosion protection on all metal anchor components. -Verified use of proper pea gravel <br />backfill and witnessed initial backfilling with pea gravel. <br />Left a UST installation Inspection Completion sign off sheet on site with Adolf A scot. <br />This facility is not approve to operate the UST system. <br />*-Primary Tank test according to manufacturer specification scheduled for 04/07/2022. <br />**Additional inspections are required. Refer to the approval letter dated April 4, 2023 for a list of inspections needed. <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 />Brine levels: 87 tank 6 3/4 inches, 91/dsl 7 1/4 inches, Bio 20/E 85 3 3/4 inches. <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: <br />EH Specialist: PAUL NSO <br />Name and Title: E mail report to: Muhammad Bilal, O <br />Phone: (209) 616-3049 <br />SR0086111 SC298 04/05/2023 <br />EHD 23-01 Rev. 07/05/2022 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />