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S A N J 0 A Q I I I Irl Environmental Health Department <br /> CCUN r <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Address: Date: <br /> COUNTRYSIDE LIQUORS&GAS 14971 N HWY 88 , LODI March 30, 2020 <br /> SUMMARY OF VIOLATIONS <br /> (CLASS I,CLASS II,or MINOR-Notice to Comply) <br /> Item# Remarks <br /> 123 CCR 2637.1(d), 2637.1(e)Failure to submit the"Spill Container Testing Report Form"within 30 days after the test. <br /> OBSERVATION:A spill container test was performed on 7/23/2019 under service request number SR0080608. A <br /> test report has not been submitted to the EHD or the California Environmental Reporting System (CERS). <br /> REGULATION GUIDANCE:A copy of the test report must be submitted within 30 days of the test. <br /> CORRECTIVE ACTION: Immediately provide this report to the EHD. <br /> This is a minor violation. <br /> FA0000540 PR0231911 SCO01 03/30/2020 <br /> EHD 23-01 Rev.9/20/2019 Page 4 of 6 Underground Storage Tank Program OIR <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />