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r SANJOAQUI Environmental Health Department <br /> C U N T Time In:Time Out: <br /> Greatness grows here, <br /> Underground Storage Tank Program Service Request Inspection Report <br /> Name of Facility: SAFEWAY 0055 FUEL Date: 04/21/2022 <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: Les Henderson ICC Service Tech/Installer Exp. Date: 03/28/2023 <br /> Manufacturer training: NOV, 04/09/24 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> On site to verify the secondary piping slope is at 1/8 inch (or greater)to a containment sump with an audible/visual alarm. <br /> Verified all piping setbacks, cross-overs, and burial depth are according to manufacturer's guidelines. <br /> Additional inspections are required. Please refer to approval letter dated December 3, 2021 item number 5. Send written <br /> inspection requests to UST@sjgov.org with a 48-hour notice. <br /> To minimize person to person contact EHD is choosing to write the name of person receiving the report instead of having them <br /> sign. <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: VICKY VANG-LEE Phone: (209)616-3028 <br /> SR0083832 SC131 04/21/2022 <br /> EHD 23-01 Rev.09/16/2020 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />