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Time In: <br /> Time Out: <br /> opQ.�tN. San Joaquin County <br /> .X Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �... P Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> �<<FORtN <br /> Underground Storage Tank Program Service Request Inspection Report <br /> Name of Facility: GSG GAS&MART Date: 05/13/2020 <br /> Address: 701 E DR MARTIN LUTHER KING JR BLVD , STOCKTON 95206 <br /> Requestor: MEGAN MITCHELL, ELITE IV CONTRACTORS Telephone: (209)461-6337 <br /> Program Element: 2308-UST RETROFIT Request#: SR0081338 <br /> Inspection Type: 298-UST RETROFIT REPAIR INSPECTION <br /> Onsite Service Technician: Mike Kennard ICC Service Tech/Installer Exp. Date: 06/19/2021 <br /> Manufacturer training: ICC Install, 06/19/21; OPW, 05/31/21 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> Onsite to verify corrosion protection on the 87 and 91 spill containers prior to backfilling. <br /> Still needed: <br /> -Overfill prevention verification on the 87 and 91 tanks <br /> -One hour hydrostatic testing or equivalent on the 87 and 91 spill containers <br /> -Verify minimum 5 gallon capacity <br /> -Verify drainage <br /> -Secondary containment testing on the 87 and 91 tanks <br /> NOTE: This service request is not complete at this time. Provide 48 hour notification for these tests to the EHD and submit test <br /> results within 30 days of testing. <br /> To minimize person to person contact EHD is choosing to write the name of person receiving the report instead <br /> of having them 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: Mike Kennard, Service Technician <br /> EH Specialist: SHEWIT WOLDEAREGAY Phone: (209)468-0216 <br /> FA0002512 SR0081338 SC298 05/13/2020 <br /> EHD 23-01 Rev.06/30/15 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />