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� IUU I Environmental Health Department <br /> COUNTY- Time In: <br /> +JC _fF AMENDED 12/18/2020 Time Out: <br /> Greatness grows hef�:, V. Vang-Lee <br /> Underground Storage Tank Program Service Request Inspection Report <br /> Name of Facility: 7-ELEVEN INC#20632 Date: 12/18/2020 <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: Tim Hardin ICC Service Tech/Installer Exp. Date: 06/28/2021 <br /> Manufacturer training: VR, 01/24/22; OPW, 02/20/21 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> On-site for pre-fuel inspection. The following items were verified: <br /> 1)vacuum communication <br /> 2)installation of appropriate test ports and verified that no additional shut-off valves were installed <br /> 3)installation of VPH components <br /> 4)overfill prevention for 87, 91, and diesel <br /> 5)spill container for 87, 91 and diesel holds a minimum of 5 gallons, passed 1 hour hydrostatic test, and has proper drainage <br /> 6)monitoring system functionality <br /> This site has a valid California Department of Tax and Fee Administration (CDTFA)number. <br /> Passing Enhanced Leak Detection (ELD)test results received. <br /> Dispenser footprints are not contained by the UDCs. Contractor Larry states deflector plates have been ordered and will be <br /> installed and ready for the final inspection. <br /> **This site is approved to receive fuel, NOT to operate** <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: Emailed to Larry Carpenter, Contract <br /> EH Specialist: VICKY VANG-LEE Phone: (209)616-3028 <br /> FA0002541 SR0079419 SC131 12/18/2020 <br /> EHD 23-01 Rev.09/16/2020 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />