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r S � OAQUIN Environmental Health Department <br /> -COUNTY <br /> Grrarness grows here. <br /> Service Request Inspection Report <br /> Name of Facility: LODI CHEVRON Date: 06/11/2024 <br /> Address: 601 E KETTLEMAN LN , LODI 95240 <br /> Requestor: MARGARET SMITH, BZ MAINTENANCE Telephone: (916)371-2380 <br /> Program Element: 2308- UST RETROFIT Request#: SR0087856 <br /> Inspection Type: 4297- UST RETROFIT REPAIR INSPECTION <br /> Onsite Service Technician: Jeff Raven ICC Service Tech/Installer Exp. Date: 07/01/2025 <br /> Manufacturer training: PEI RP 1200, 01/30/26 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> Witnessed secondary containment testing on the 91 underground storage tank(UST). <br /> Passed. <br /> Submit test results to the Environmental Health Department(EHD)within 30 days of the test. Email reports to ust@sjgov.org. <br /> To minimize person to person contact the EHD is choosing to write the name of person receiving the report instead of having <br /> them 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: Name and Title: Margaret Smith, Contractor <br /> EH Specialist: VICKY VANG-LEE Phone: (209)616-3028 <br /> FA0003803 SR0087856 SC4297 06/11/2024 <br /> EHD Rev.09/16/2020 Page 1 of 1 Service Request Inspection Report <br />