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San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 468-3433 Web:www.soclov.org/ehd <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Address: date: <br /> Costco Wholesale#658 3250 W GRANT LINE RD, Tracy September 22, 2016 <br /> Complete and submit a copy of the Return to Compliance Certification form to the EHD with a statement <br /> documenting the corrective actions that have been or will be taken for each violation, and any supporting <br /> paperwork, by October 22, 2016. <br /> AFTER THE COMPLIANCE DATE, EHD WILL BILL FOR ALL TIME AND ACTIVITIES ASSOCIATED WITH BRINGING <br /> THIS FACILITY BACK INTO COMPLIANCE. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT END'S CURRENT HOURLY RATE. <br /> Received by: <br /> Date: September 22, 2016 F Inspector: Inspector Phone: <br /> Printed Name and Title: GARRETT BACKUS, Lead Senior REHS (209)468-2986 <br /> Tony Haggard, Supervisor <br /> FA0013810 PR0518288 SC001 09/2212016 <br /> EHD 23-01 Rev.09/22116 Page 4 of 4 Underground Storage Tank Program 0!R <br />