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SANOAQU I N Environmental Health Department <br /> COU NI T Y I Y Time In: <br /> + _,fr Time Out: <br /> . •- Greotr+ess �row3 here, <br /> Underground Storage Tank Program Service Request Inspection Report <br /> Name of Facility: CHEVRON STATION#94275* Date: 01/21/2022 <br /> Address: 2905 W BENJAMIN HOLT DR , STOCKTON 95207 <br /> Requestor: WAYNE PERRY INC,WAYNE PERRY INC Telephone: (916)646-9680 <br /> Program Element: 2308-UST RETROFIT Request#: SR0083414 <br /> Inspection Type: 298-UST RETROFIT REPAIR INSPECTION <br /> Onsite Service Technician: Dean Walker ICC Service Tech/Installer Exp. Date: 02/19/2022 <br /> Manufacturer training: OPW, 03/19/22 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> On site for the following inspections on 87, 91 and diesel tanks. <br /> 1)Spill Containers 87, 91 and diesel <br /> -Verified 5 gallon capacity <br /> -Witnessed one hour hydrostatic test, all passed <br /> -Drainage not verified: Drainage valve is sealed, technician stated per chevron policy drainage valves intentionally sealed <br /> because they do not want hazardous substances drop into the tank. Called Charles Bittle(Environmental Contact)he confirm <br /> policy. Checked with store Manager spill pump and container on site. <br /> 2)Overfill prevention equipment.-Measurement of drop tubes, 87, 91 and diesel <br /> -Verified ball floats, no ball floats present, ball float cage in place without the ball <br /> -Verified flapper functionality <br /> -Verified drop tubes measurement set at below 95%tank volume shut off. <br /> This facility is approve to receive fuel in the 87, 91, and diesel tanks.To minimize person to person contact EHD is choosing to <br /> write the name of person receiving the report instead of having 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: E mail report to: Charles Bittle, Enviro <br /> EH Specialist: PAUL NSO Phone: (209)616-3049 <br /> FA0003712 SR0083414 SC298 01/21/2022 <br /> EHD 23-01 Rev.09/16/2020 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />