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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: CHEVRON Date: 08/07/2023 <br /> Address: 1222 W ATHERTON DR , MANTECA 95337 <br /> Requestor: CHEVRON LICENSE&PERMITS SPECIALIST, CHEVRON Telephone: (925)842-9002 <br /> Program Element: 2303-UST/PIPING INSTALLATION Request#: SR0084544 <br /> Inspection Type: 298-UST SERVICE REQUEST- FIELD ACTIVITY <br /> Onsite Service Technician: Jesse Pulido ICC Service Tech/Installer Exp. Date: 12/22/2024 <br /> Manufacturer training: VR, 06/20/24 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> On site for the following inspection before fuel delivery: <br /> -Verified dispenser footprints contained by the UDC's, deflector plates install for fuel filters to drain into UDCs at ends of <br /> UDCs. <br /> -Verified VPH components installations(Shroud boots, band clamps for spill containers, rubber gaskets on lids ) <br /> -Verified overfill protection equipment-measurement of drop tubes set at below 95%. <br /> -Witnessed spill container test, one hour hydrostatic test <br /> -Verified 5 gallon capacity and drainage. <br /> -Witnessed monitoring system functionality testing of 208 and 209 sensors only. <br /> -Verified CDTFA numberPassed. <br /> To minimize person to person contact EHD is choosing to write the name of person receiving the report instead of having <br /> them sign. <br /> This facility is NOT approve to receive fuel at this time. <br /> "Additional inspections are required before fuel delivery . Refer to the approval letter dated August 1, 2022 for a list of <br /> inspections needed. <br /> Technician#2 <br /> Jesus Saldivar: ICC 5/16/2025, OPW 1/4/2025 verified over fill drop tube measurements, spill container one hour hydrostatic <br /> test. <br /> *Unable to verify diesel spill container and drop tube flapper functionality. <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: E mail report to: Chevron Permit S., L <br /> EH Specialist: PAUL NSO Phone: (209)616-3049 <br /> SR0084544 SC298 08/07/2023 <br /> EHD 23-01 Rev.07/05/2022 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />