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°• Environmental Health Department <br />�. �J r� SHAWN <br />t 7Y- L. <br />Y <br />ttlir-' COUNTY— <br />Greol less grows he:. . <br />Underground Storage Tank Program Service Request Inspection Report <br />Name of Facility: MOUNTAIN HOUSE CHEVRON <br />Date: 11/29/2022 <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: Ariel Barrantes <br />ICC Service Tech/Installer Exp. Date: 09/14/2023 <br />Manufacturer training: NOV, 12/04/22; Bravo, 01/23/23 <br />OVERALL INSPECTION NOTES AND COMMENTS <br />NOTES <br />On site inspection: <br />- Witnessed one hour pneumatic pressure test of primary piping for vent lines (87, 91 and diesel), product lines (87, 91 and <br />diesel) and vapor return <br />- Witnessed primary piping soap test <br />- Witnessed one hour pressure test for UDC 1, 2, 3, 4, 5, 6 and vent box annular spaces <br />Additional inspections are required. Please refer to approval letter dated August 10, 2022, item 5 for list of required <br />inspections. Submit all inspection requests in writing to UST@sjgov.org with 48-hour advanced notice. <br />NOTE: Facility is not approved to receive fuel or operate <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 11/29/2022 <br />EHD 23-01 Rev. 07/05/2022 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />