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SANOAQU I N Environmental Health Department <br /> COU NI T Y I Y Time In: <br /> + _,fr Time Out: <br /> . •- Greotr+ess �row3 here, <br /> Underground Storage Tank Program Service Request Inspection Report <br /> Name of Facility: COUNTRY MART GAS& FOOD Date: 08/19/2021 <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: <br /> Manufacturer training: NOV, 02/14/22 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> On site to: <br /> -Witness one hour pressure test. Pressure held for 1 hour at 5 psi <br /> -Witness secondary piping soap test. No leaks observed. <br /> -Verified piping is sloped at least 1/8 of an inch and flows toward containment sump <br /> -Verified piping, setbacks, crossovers and burial depth is appropriate to manufacturer's requirements <br /> -Verified 24 hour hydrostatic test on UDCs.Water level held levels. <br /> Additional inspections are needed. See approval letter SR0083263(amended#2)dated june 17, 2021 for more information. <br /> -Verification of dispenser footprints contained within UDCs <br /> -Sensor functionality <br /> -Secondary containment test on diesel <br /> Facility is not approved to operate diesel UST system or receive fuel in the diesel tank until final inspections completed. <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: Joseph Bartholdi, Service Technician <br /> EH Specialist: CAROL PRESTO Phone: (209)616-3061 <br /> FA0003290 SR0083263 SC298 08/19/2021 <br /> EHD 23-01 Rev.09/16/2020 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />