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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: 07/23/2019 <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: Christopher Adams ICC Service Tech/Installer Exp. Date: 04/19/2020 <br /> Manufacturer training: OPW, 05/23/21 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> On site for the following inspections: <br /> -Witnessed 5 gallon capacity of 91 direct-bury spill container. <br /> -Verified drainage. <br /> -Witnessed 1 hour hydrostatic testing for 91 direct-bury spill container. Passed <br /> This facility is approved to operate. <br /> NOTE: Corrosion protection for the 91 product direct-bury spill container prior to backfilling was verified on 7/17/2019. <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 /> 02____j &_ <br /> Received by: Name and Title: Christopher Adams, Service Tech <br /> EH Specialist: SHEWIT WOLDEAREGAY Phone: (209)468-0216 <br /> FA0000540 SR0080608 SC298 07/23/2019 <br /> EHD 23-01 Rev.06/30/15 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />