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SANJOAQUI Environmental Health Department <br />f Grectness grows Frere, <br />Underground Storage Tank Program Service Request Inspection Report <br />Name of Facility: MOUNTAIN HOUSE CHEVRON <br />Date: 12/07/2022 <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, 12/04/23; Bravo, 01/23/23 <br />OVERALL INSPECTION NOTES AND COMMENTS <br />NOTES <br />On-site for the following: <br />-Witnessed secondary piping pressure and soap test of the product, vent, and vapor recovery including penetrations. All <br />Passed <br />-Witnessed integrity testing of all sumps per manufacturers' installation instructions. All passed. <br />- Verified proper brine manufacturer. <br />-Verified brine filling was conducted in accordance with manufacturer instructions. Witnessed the addition of brine in sumps <br />and UDCs. <br />-Verified all pipe setbacks, cross -overs, and burial depth according to the manufacturer's installation instructions. <br />*Additional inspections are needed. Refer to the approval letter for a list of required inspections.* <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: SHEWIT WOLDEAREGAY <br />Name and Title: Emailed to Latham Zubillaga, Contrac <br />Phone: (209) 616-3063 <br />SR0084001 SC298 12/07/2022 <br />EHD 23-01 Rev. 07/05/2022 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />