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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: COUNTRYSIDE LIQUORS&GAS Date: 07/17/2019 <br /> Address: 14971 N HWY 88 , LODI 95240 <br /> Requestor: MEGAN MITCHELL, ELITE IV CONTRACTORS Telephone: (209)461-6337 <br /> Program Element: 2308-UST RETROFIT Request#: SR0080608 <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: OPW, 05/31/21 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> On site to verify corrosion protection for the 91 product direct-bury spill container prior to backfilling.The bottom of the <br /> 1C-2100C-DVR series product fill spill container along with the riser were covered with a 10 MIL tape; meeting corrosion <br /> protection requirements. <br /> This service request is not completed at this time. <br /> NEEDED: <br /> -Verification of 5 gallon capacity of the 91 product spill container. <br /> -Hydrostatic testing of the 91 product spill container. <br /> -Verification of proper drainage of the 91 product spill container. <br /> *Please be aware that the facility cannot receive fuel in the 91 product tank prior to the EHD inspection and approval. <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 Tech <br /> EH Specialist: SHEWIT WOLDEAREGAY Phone: (209)468-0216 <br /> FA0000540 SR0080608 SC298 07/17/2019 <br /> EHD 23-01 Rev.06/30/15 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />