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r I Environmental Health Department <br /> - I <br /> COUNTY— <br /> Greatness <br /> U T <br /> Greatness grows here, <br /> Underground Storage Tank Program Service Request Inspection Report <br /> Name of Facility: BlackHawk Petroleum Inc Date: 01/05/2024 <br /> Address: 5611 E WATERLOO RD , STOCKTON 95215 <br /> Requestor: CARRIE MILLER, ELITE IV CONTRACTORS Telephone: (209)461-6337 <br /> Program Element: 2308-UST RETROFIT Request#: SR0087536 <br /> Inspection Type: 298-UST SERVICE REQUEST- FIELD ACTIVITY <br /> Onsite Service Technician: Benjamin Malaspina ICC Service Tech/Installer Exp. Date: 06/05/2024 <br /> Manufacturer training: OPW, 06/30/25 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> Witnessed the 87 and diesel spill containers one hour hydrostatic test. <br /> -Verified 5-gallon capacity <br /> -Verified proper drainage <br /> All passed <br /> This facility is approve to receive fuel in the 87 and diesel tanks. <br /> Note: Since concrete was broken near the 87 and diesel tanks, a secondary containment test must be performed in <br /> accordance with the manufacturer's guidelines. <br /> To minimize person to person contact EHD is choosing to write the name of person receiving the report instead of having <br /> them 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 report to:Nazish Hussain, Envi <br /> EH Specialist: PAUL NSO Phone: (209)616-3049 <br /> FA0002160 SR0087536 SC298 01/05/2024 <br /> EHD 23-01 Rev.07/05/2022 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />