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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: CHEVRON Date: 01/22/2020 <br /> Address: 4344 WATERLOO RD , STOCKTON 95215 <br /> Requestor: WAYNE PERRY INC Telephone: (916)834-5717 <br /> Program Element: 2308-UST RETROFIT Request#: SR0081653 <br /> Inspection Type: 298-UST RETROFIT REPAIR INSPECTION <br /> Onsite Service Technician: Don Baughn ICC Service Tech/Installer Exp. Date: 04/12/2020 <br /> Manufacturer training: Franklin Fueling, 04/11/20 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> On site for the following inspections: <br /> -Verified overfill measurements and calculations for the Defender Series Overfill Prevention w/flapper valve in the 87 tank. <br /> The Overfill Prevention Equipment were already constructed and inside the tank before the inspector was onsite. The Overfill <br /> Prevention Equipment was pulled out during the service request inspection and 95%tank volume shut off was verified. <br /> -Verified flapper functionality. <br /> -Verified 5 gallon capacity. <br /> -Verified drainage. <br /> -Witnessed one hour hydrostatic testing of the 87 spill container. All passed. <br /> NOTE-This facility is approved to receive fuel in the 87 tank. This service request is complete. <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: Don Baughn, Foreman v <br /> EH Specialist: SHEWIT WOLDEAREGAY Phone: (209)468-0216 <br /> FA0008112 SR0081653 SC298 01/22/2020 <br /> EHD 23-01 Rev.06/30/15 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />