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Environmental Health Department <br />AMENDED <br />8/30/2021 <br />Underground Storage Tank Program Inspection Report <br />Date: <br />June 24, 2021 <br /> Facility Address: <br /> 4405 PACIFIC AVE, STOCKTON <br /> Facility Name: <br /> 7-ELEVEN INC #41341 <br />Complete and submit a copy of the Return to Compliance Certification form to the EHD with a statement <br />documenting the corrective actions that have been or will be taken for each violation, and any supporting <br />paperwork, by September 30, 2021. <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. Starting September 1, 2018, all in-office CERS help will be provided at EHD hourly rate <br />($152). To schedule an appointment, please call (209) 468-3420. <br />Documents provided during inspection: Return to Compliance certification, flyer for free CUPA classes <br />Notes: Witnessed monitoring certification, primary and secondary containment testing. All components passed <br />per technicians Brent Bowen (Tanknology), Jarrod Cooke (Tanknology) and David Delgado (Walton). <br />Service Techs: <br />Jarrod Cooke, ICC tech 3/18/2023, VPLT 3/21/2023 <br />David Delgado, ICC tech 12/6/21, Modern Welding 3/30/2022, NOV Fiber Glass Systems' TQIP 1/2/2023 <br />AFTER THE COMPLIANCE DATE, EHD WILL BILL FOR ALL TIME AND ACTIVITIES ASSOCIATED WITH BRINGING <br />THIS FACILITY BACK INTO COMPLIANCE. <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> Received by: Inspector Phone: <br /> LYDIA BAKER, REHS <br /> Inspector:August 30, 2021 Date: <br />Printed Name and Title: <br />Emailed to Ethan Valburg, Regional Gasoline ECS <br />(209) 616-3046 <br />FA0007787 PR0508452 SC001 06/24/2021 <br />EHD 23-01 Rev. 9/16/2020 Underground Storage Tank Program OIRPage 7 of 7 <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/EHD