Laserfiche WebLink
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: SAFEWAY 0055 FUEL Date: 04/06/2022 <br /> Address: 19533 S MOUNTAIN HOUSE PKWY, MOUNTAIN HOUSE 95391 <br /> Requestor: STIG WERELIUS, STANTEC ARCHITECTURE, INC. Telephone: (707)774-8333 <br /> Program Element: 2303-UST/PIPING INSTALLATION Request#: SR0083832 <br /> Inspection Type: 131 -UST INSTALLATION INSPECTION <br /> Onsite Service Technician: Leslie Henderson ICC Service Tech/Installer Exp. Date: 03/28/2023 <br /> Manufacturer training: NOV, 02/07/22 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> On site inspection: <br /> -Witnessed primary soap test of all piping and penetrations <br /> -Witnessed one hour pneumatic pressure test at 110%of operating pressure or 40 psi,whichever is greater(pressure <br /> remained the same for 1 hour) <br /> Please see approval letter dated December 3, 2021 for list of additional inspections and additional permit details. Request <br /> inspections with a 48-hour notice by emailing UST@sjgov.org. <br /> Note: Please provide current NOV certification for Leslie Henderson. Certification can be emailed to me at cpresto@sjgov.org <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 Les Henderson, Contracto <br /> EH Specialist: CAROL PRESTO Phone: (209)616-3061 <br /> SR0083832 SC131 04/06/2022 <br /> EHD 23-01 Rev.09/16/2020 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />