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S A N J Q Q Q U IN Environmental Health Department <br /> C O U N T Y Time In: <br /> Time Out: <br /> Greorness grows here. <br /> Underground Storage Tank Program Service Request Inspection Report <br /> Name of Facility: 7-ELEVEN INC#20632 Date: 12/04/2020 <br /> Address: 4627 DA VINCI DR , STOCKTON 95207 <br /> Requestor: NICHOLAS ROWE, LC SERVICES Telephone: (559)892-5287 <br /> Program Element: 2303-UST/PIPING INSTALLATION Request#: SR0079419 <br /> Inspection Type: 131 -UST INSTALLATION INSPECTION <br /> Onsite Service Technician: Solomon Untalon ICC Service Tech/Installer Exp. Date: 12/04/2020 <br /> Manufacturer training: Xerxes, 12/18/20 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> On site to witness installation of 3 underground storage tanks. <br /> -one 20 thousand gallon Xerxes tank <br /> -one 20 thousand gallon Xerxes split tank(end tank is 8 thousand gallons, and base tank is 12 thousand gallons) <br /> Inspected tank prior to installation <br /> -inspected tank for evidence of brine leaks. No leaks were observed. <br /> -verified UL labeling on all tanks <br /> -interior of tank was inspected by the ICC installer on site who stated tank was clean and brine-free <br /> -verified the use of the manufacturer's installation checklist at the time of the inspection <br /> Other observations during inspection: <br /> -verified presence of deadman and use of anchor straps <br /> -witnessed tank set <br /> -verified the use of appropriate backfill <br /> -verified application of additional corrosion protection on tank anchors and all exposed metal <br /> -witnessed backfilling of the tank pit and probing of pea gravel <br /> Primary tank test: <br /> -verified testing was in accordance to manufacturer's specifications <br /> -pressure at 5psi for one hour <br /> -passed <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: Larry Carpenter, Contractor <br /> EH Specialist: VICKY VANG-LEE Phone: (209)616-3028 <br /> FA0002541 SR0079419 SC131 12/04/2020 <br /> EHD 23-01 Rev.09/16/2020 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />