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i �� I I I AI Environmental Health Department <br /> YSA N U N <br /> rT�z wti COUNTY Time In: <br /> Time Out: <br /> Greotr+ess �rGws here, <br /> Underground Storage Tank Program Service Request Inspection Report <br /> Name of Facility: COUNTRY MART GAS& FOOD Date: 08/17/2021 <br /> Address: 34243 S CHRISMAN RD , TRACY 95304 <br /> Requestor: DEBORAH JONES, ELITE IV CONTRACTORS Telephone: (209)461-6337 <br /> Program Element: 2308-UST RETROFIT Request#: SR0083263 <br /> Inspection Type: 298-UST RETROFIT REPAIR INSPECTION <br /> Onsite Service Technician: Joseph Bartholdi ICC Service Tech/Installer Exp. Date: 04/13/2023 <br /> Manufacturer training: NOV, 02/14/22 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> On site to witness: <br /> -Primary piping soap test. No leaks observed. <br /> - 1 hour pneumatic pressure test. Piping held 50 psi held for 1 hour. UDCs held 5 psi for 1 hour. <br /> Additional inspections are needed. Please refer to item#3 on approval letter SR0083263 (amended#2)dated June 17, 2021 <br /> for list of required inspections. <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: Jospeh Bartholdi, Service Technician <br /> EH Specialist: CAROL PRESTO Phone: (209)616-3061 <br /> FA0003290 SR0083263 SC298 08/17/2021 <br /> EHD 23-01 Rev.09/16/2020 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />