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Time In: <br />Time Out: <br />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA95205-6232 <br />• i •.. ;� • Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sj oq v.org/ehd <br />06, <br />Underground Storage Tank Program Service Request Inspection Report <br />Name of Facility: CITY GAS & LIQUOR <br />Date: 01/07/2019 <br />Address: 16470 CAMBRIDGE ST, LATHROP 95330 <br />Requestor: AMARJIT KHINDA, CITY GAS & LIQUOR <br />Telephone: (209) 321-4134 <br />Program Element: 2303 - UST/PIPING INSTALLATION <br />Request #: SR0076483 <br />Inspection Type: 131 - UST INSTALLATION INSPECTION <br />Onsite Service Technician: Joseph Bartholdi <br />ICC Service Tech/Installer Exp. Date: 11/08/2020 <br />Manufacturer training: Veeder-Root, 02/03/19 <br />OVERALL INSPECTION NOTES AND COMMENTS <br />NOTES <br />On site for the following: <br />-Verified brine level in the 91/diesel tank annular. <br />-Verified the monitoring panel reads'All functions normal.' <br />-Received the completed tank installation checklist. <br />-Verified vacuum communication on all product piping, vapor recovery piping, and vent piping. <br />-Verified installation of fiberglass Bravo Retrofit Plates attached to the metal UDCs on dispensers 3/4 and 7/8. Additional <br />approval is needed from the manufacturer to confirm installation is adequate. <br />-Assisted the owner, AJ Khinda, with CERS documents. The site map is incomplete and inaccurate. The CERS submittal coulc <br />not be completed. <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 />t���,_JCA <br />Received by: Name and Title: Amariit Khinda, Owner <br />EH Specialist: <br />STACY RIVERA <br />Phone: (209) 468-3440 <br />FA0000185 SR0076483 SC131 01/07/2019 <br />EHD 23-01 Rev. 06/30/15 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />