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SAN JOAHI <br />CQU NTY <br />' SS grows hvj— <br />Environmental Health Department <br />Time In: <br />Time Out: <br />Underground Storage Tank Program Service Request Inspection Report <br />Name of Facility: ARCO AM/PM MANTECA <br />Date: 05/26/2020 <br />Address: 2050 CRESTWOOD AVE, MANTECA 95336 <br />Requestor: CHRIS BROWN, PM DESIGN GROUP ONC (SUITE 102) <br />Telephone: <br />(707) 921-1204 <br />Program Element: 2303 - UST/PIPING INSTALLATION <br />Request #: <br />SR0078213 <br />Inspection Type: 131 - UST INSTALLATION INSPECTION <br />Onsite Service Technician: Chris Adams <br />ICC Service Tech/Installer Exp. Date: <br />09/01/2020 <br />Manufacturer training: VR, 10/08/21; OPW, 05/23/21 <br />OVERALL INSPECTION NOTES AND COMMENTS <br />NOTES <br />On site for the following: <br />- Verified dispenser footprints contained by the UDC's, fuel filters drain into UDCs and no potential leaks from piping. <br />- Verified VPH components installations( Shroud boots, band clamps for spill containers, rubber gasket on lids on fill and STP <br />sumps.) <br />- Verified overfill protection external audible/visual alarm activates when tank is 90% full. <br />- Witnessed spill container test, one hour hydrostatic test- Passed <br />- Verified 5 gallon capacity Passed <br />- Witnessed monitoring system functionality testing - Passed. <br />- Verified communication (vacuum and brine) in UDCs, vent, fill and STP sumps - Passed <br />- Verified end point of each vacuum zones. <br />To minimize person to person contact EHD is choosing to write the name of person receiving the report instead <br />of having them sign. <br />This facility is not approve to receive fuel until we receive a valid CDTFA(BOE) number and ELD test results.**Additional <br />inspections are required. Refer to the approval letter dated July 26, 2019 for a list of inspections needed. <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: Don Gilmer, Project Manager <br />Phone: (209) 468-3432 <br />SR0078213 SC131 05/26/2020 <br />EHD 23-01 Rev. 06/30/15 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />