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SAN 10At IN nvironniental Ilealt � Department Underground Storage Tank Program lnspec#ion Report Facility Name: Facility Phone : Date: Costco Wholesale #38 (Gas Station ) (209 ) 478-2040 March 13 , 2019 Facility Address : CERS ID: 1630 E Hammer Ln , Stockton , CA 95210 10749253 Inspection Contact: Title : Phone : Lisa Hurley Environmental Contact (425 ) 427 -7885 Inspection Type: Program: ROUTINE INSPECTION - Operating Permit 2371 - UST FACILITY - 1702 COMPLIANT Consent For: Consent Given By : Z Inspection O Photos O Samples Rick Sickels , Shipping and Receiving Manager Service Technician Onsite: Exp. Date: Designated Operator: Exp. Date : Chad White 02/23!2020 Mark Rasmussen 12/27/2019 Service Technician Manufacturer's Training : Veeder Root, 06/08/ 19 ; VMI , 05/23/ 19 ; SB , 05/30/20 CCR = Title 23 California Code of Regulations HSC = Health and Safely Code CFR = Code of Federal Regulations V = Violation R = Repeat violation COS = Corrected on site during inspection . . File' Revievv 101 HSC 25284 Failed to obtain a permit to operate from the EHD including but not limited to unpaid permit fees zV 1R 1 COS 102 HSC 25284(a) (3) (A)/(B) No written agreement between tank owner and tank operator to monitor the tank system V R r COS 103 HSC 25292. 27 25299.30 Failure to submit and maintain complete and current financial responsibility documents V R ICOS 104 CCR 2711 UST operating permit application for facility and tank information not submitted or current V - R COS 105 CCR 2632(d)(1 ) , Failed to have an approved UST monitoring plan IV R COS 2634(d) 106 CCR 2632(d)(2) , Failed to have an approved UST response plan IV R : COS 2634(e) 107 CCR 2632(d)(1 ) (C) Plot plan/site map not submitted or failed to completely show where monitoring is performed V R COS 108 CCR 2637, 2638(e) , Failed to notify the EHD 48 hours prior to conducting testing V R COS 2643(g) r1141 CCR 2637(a-d) , 2712 Failed to test secondary containment, or failed to maintain test records for 36 months V R COS CCR 2637(e) , 2637(0 Failed to submit "Secondary Containment Testing Report Form" within 30 days after the test V R COS CCR 2638(a) & (b) , Failed to test monitoring and leak detection equipment annually V r R COS 26410) HSC 25293 Failure to maintain UST records to enable the UPA to determine whether the UST is in compliance n V R COS 113 CCR 2638(c) , 2638(d) Failure to submit "Monitoring System Certification Form" within 30 days of completion of the test IV R COS 114 CCR 2636(0(3) , 2643(c) No 0. 1 gph annual line integrity test for pressurized piping , or within 30 days after repair V R COS (3) 115 CCR 2715(a) (1 ) (B) , "Designated Underground Storage Tank Operator Identification Form" not submitted within 30 days V R COS 2715(a) (3) 116 CCR 2715 Designated operator, service tech or installer did not possess current ICC certification V R z. COS 117 CCR 2663, 2712(b)(6) Failure to comply with tank lining. recordkeeping , and inspection requirements V R COS 118 CCR 2715(a)(1 ) (A) , Failure to submit the "Underground Storage Tank Statement of Understanding and Compliance Form" IV iR COS 2715(a) (2) 119 HSC 25299(a)(8) , Documents were falsified or misrepresented V IR COS 25299(b)(7) 120 CCR 2635(d) Failed to submit UST Certification of Installation/Modification IV I R COS 121 CCR 2712(0 Failed to submit a written response within 30 days of receiving an inspection report V R COS 122 CCR 2631 , 2640. 1 , Failure to submit and/or maintain documentation regarding compatibility for UST system components IV R COS 2665 , 2711 FA0024496 PRO518624 SCO01 03/1312019 EHD 23-01 Rev. 09/28/2018 Page 1 of 4 Underground Storage Tank Program OIR 1868E Hazelton Avenue j Stockton . California 952051 T 209 468-3420 1 F " 09 .1 0 L'> i „n, coil com