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SAN JUAOUIN <br />Environmental Health Department <br />Amended 8/18/2022 <br />Underground Storage Tank Program Service Request Inspection Report <br />Name of Facility: MOUNTAIN HOUSE CHEVRON <br />Date: 08/18/2022 <br />Address: 1124 INTERNATIONAL PKWY, TRACY 95377 <br />Requestor: MR MUTHANA IBRAHIM, M I ARCHITECTS, INC. <br />Telephone: (925) 287-1174 <br />Program Element: 2303 - UST/PIPING INSTALLATION <br />Request #: SR0084001 <br />Inspection Type: 298 - UST RETROFIT REPAIR INSPECTION <br />Onsite Service Technician: Latham Zubillaga <br />ICC Service Tech/Installer Exp. Date: 01/05/2024 <br />Manufacturer training: Xerxes, 03/04/23 <br />OVERALL INSPECTION NOTES AND COMMENTS <br />NOTES <br />On site inspection: <br />- Walked around 20,000 -gallon 87 Xerxes tank, no leaks observed outside of tank <br />- Walked around 20,000 -gallon split (10,000-gallon/10,000-gallon 91/diesel) Xerxes tank, no leaks observed outside of tank <br />- Verified tank manufacturer, capacity and UL labels <br />- Verified with contractor that there were no issues observed inside the tanks <br />- Witnessed tank set of 20,000 -gallon 87 tank and 20,000 -gallon 91/diesel split tank <br />- Verified tank orientation matches plans <br />- Verified manufacturer checklist on site <br />- Witnessed additional corrosion protection applied <br />- Witnessed start of backfill and probing <br />Additional inspections are required. Please see approval letter dated August 10, 2022, section 5 for list of inspections. Please <br />submit all inspection requests in writing to UST@sjgov.org with 48-hour advanced notice. <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: CAROL PRESTO <br />Name and Title: Emailed to Latham Zubillaga, Contrac <br />Phone: (209) 616-3061 <br />SR0084001 SC298 08/18/2022 <br />EHD 23-01 Rev. 07/05/2022 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />