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r SANJOAQUI Environmental Health Department <br />C U T Time In: Time Out: <br />Greatness grows here, <br />Underground Storage Tank Program Service Request Inspection Report <br />Name of Facility: DBA CIRCLEK, REFUEL PETROLEUM INC. <br />Date: 07/09/2021 <br />Address: 419 S MAIN ST, MANTECA 95336 <br />Requestor: TONY MEHROKE, TANK TIGHT <br />Telephone: (916) 753-0177 <br />Program Element: 2308 - UST RETROFIT <br />Request #: SR0083905 <br />Inspection Type: 298 - UST RETROFIT REPAIR INSPECTION <br />Onsite Service Technician: FF(SB) <br />ICC Service Tech/Installer Exp. Date: 12/22/2021 <br />Manufacturer training: <br />OVERALL INSPECTION NOTES AND COMMENTS <br />NOTES <br />On Site for the following inspection: <br />-Verified corrosion protection for the 91 direct bury spill bucket prior to backfilling. <br />* This facility is not approve to receive fuel in the 91 tank . <br />Additional inspections required see approval letter dated June 29, 2021. <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: Hussian Ismail„ Operator <br />Phone: (209) 616-3049 <br />FA0003685 SR0083905 SC298 07/09/2021 <br />EHD 23-01 Rev. 09/16/2020 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />