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°• Environmental Health Department <br />�. �J r� SHAWN <br />t 7Y- L. <br />Y <br />ttlir_' COUNTY— <br />Greol less grows he:. . <br />Underground Storage Tank Program Service Request Inspection Report <br />Name of Facility: FAST N EASY MART #104 <br />Date: 06/09/2023 <br />Address: 16460 GOLDEN VALLEY PKWY, LATHROP 95330 <br />Requestor: MUHAMMAD BILAL, RIVER ISLAND CHEVRON <br />Telephone: (707) 486-8894 <br />Program Element: 2303 - UST/PIPING INSTALLATION <br />Request #: SR0086111 <br />Inspection Type: 298 - UST SERVICE REQUEST - FIELD ACTIVITY <br />Onsite Service Technician: Adolf Scot Alves <br />ICC Service Tech/Installer Exp. Date: 12/02/2024 <br />Manufacturer training: NOV, 07/23/24; CSI, 07/23/24 <br />OVERALL INSPECTION NOTES AND COMMENTS <br />NOTES <br />On site for the following inspections: <br />-Witnessed integrity testing of all tank sump at tank pit (87, 91, diesel, biodiesel, and E85) for one-hour pneumatic pressure <br />test at 5 PSI <br />-Verified secondary piping slope test for all piping at tank pit - 87, 91, diesel, biodiesel, and E85 (product, vent, vapor recovery <br />and chase) at 1/8 inch per foot or greater to the containment sumps. <br />-Verified piping burial depth, set back and cross overs at tank pit for (87, 91, diesel, biodiesel, and E85) prior to backfill <br />-Witnessed brine addition for all tank pit sumps (87, 91, diesel, biodiesel, and E85). <br />All Passed <br />This facility is not approve to receive fuel or operate the UST system see approval letter dated April 4, 2023 for additional <br />inspections. <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: <br />EH Specialist: PAUL NSO <br />Name and Title: Email report to: Muhammad Bilal, Ow <br />Phone: (209) 616-3049 <br />SR0086111 SC298 06/09/2023 <br />EHD 23-01 Rev. 07/05/2022 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />