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Time In: <br /> Time Out: <br /> opQ.�tN. San Joaquin County <br /> .X Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �... P Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> �<<FORtN <br /> Underground Storage Tank Program Service Request Inspection Report <br /> Name of Facility: Mossdale Chevron Date: 08/28/2020 <br /> Address: 444 W MOSSDALE RD , LATHROP 95330 <br /> Requestor: EMILY CRAIN, BZ MAINTENANCE Telephone: (916)371-2380 <br /> Program Element: 2308-UST RETROFIT Request#: SR0082218 <br /> Inspection Type: 298-UST RETROFIT REPAIR INSPECTION <br /> Onsite Service Technician: Rhome Desbiens ICC Service Tech/Installer Exp. Date: 02/13/2022 <br /> Manufacturer training: Incon, 02/17/22; OPW, 05/08/22 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> On site for the following inspections: <br /> -Verified corrosion protection for the 87 and 91 direct bury spill containers. <br /> -Witnessed the secondary containment testing on the 87 and diesel STP sumps. Passed <br /> "This service request is not complete. <br /> NEEDED: <br /> -Spill container test:verify minimum 5-gallon capacity and pass a one hour hydrostatic test(or equivalent). <br /> -Verification of proper drainage <br /> -Since concrete was broken near the 87 and 91 tanks, a secondary containment test must be performed once concrete is <br /> poured in accordance with the manufacturer's guidelines. <br /> NOTE: Please be aware that the facility cannot receive fuel in the 87 and 91 tanks prior to the EHD inspection and approval. <br /> As of 8/28/20, according to the facility's inventory report,the 87 tank contains 4,666 gals and the 91 tank contains 1332 gals. <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: Name and Title: Rhome Desbiens, Service Tech <br /> EH Specialist: SHEWIT WOLDEAREGAY Phone: (209)468-0216 <br /> FA0000212 SR0082218 SC298 08/28/2020 <br /> EHD 23-01 Rev.06/30/15 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />