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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> UST/ PIPING CLOSURE INSPECTION FORM <br /> SITE NAME : COSTCO WHOLESALE #658 SR# : 0084603 <br /> ADDRESS : 3250 W GRANT LINE RD CITY: TRACY <br /> OWNER NAME : COSTCO WHOLESALE CORPORTATION PHONE : 425 -313-8100 <br /> CONTRACTOR : JONES COVEY GROUP , INC PHONE . 88&972 -7581 <br /> FIRE PERMIT # : 435 TANK # 39 <br /> ® PIPING REMOVAL ❑ UST REMOVAL ❑ CLOSURE IN PLACE ❑ TEMPORARY CLOSURE <br /> INSPECTOR : Carol Presto DATE : 6/17/2022 <br /> R RINSED : [] YES ❑ NO METHOD : AMOUNT : <br /> I <br /> N RINSATE DISPOSAL SITE : <br /> S <br /> E MANIFEST # : OTHER TRACKING # : <br /> V <br /> A PURGED : ❑ YES ❑ NO METHOD : AMOUNT USED : <br /> P <br /> R READINGS AT REMOVAL : L. E . L. : 02 : COMMENTS* : <br /> C TANK MATERIAL : ❑ STEEL ❑ FIBERGLASS ❑ OTHER TANK SIZE (gal) : <br /> 0 TANK CONDITION : ❑ GOOD ❑ POOR ❑ HOLES COMMENTS*: <br /> N <br /> S PIPE MATERIAL : ❑ STEEL ® FIBERGLASS ❑ OTHER TOTAL LENGTH OF PIPING (ft) : 120 <br /> T PIPE CONDITION : ® GOOD ❑ POOR ❑ HOLES COMMENTS*: <br /> DEPTH (ft) SOIL TYPE OBSERVATION* SAMPLE # <br /> T <br /> A <br /> N <br /> K <br /> EXCAVATION SIZE (length x width x depth) : ft X ft X ft <br /> S DEPTH (ft) SOIL TYPE OBSERVATION * SAMPLE # <br /> A P 3 clay light brown , dry , no odors observed D - 1 <br /> M I 2 clay light brown , dry , no odors observed P- 1 <br /> P P 2 clay light brown , dry , no odors observed D -2 <br /> L E 2 clay light brown , dry , no odors observed P-2 <br /> NTRENCH SIZE (length x width x depth) : 60 ft X 4 ft X 6 ft <br /> GH DEPTH TO GROUNDWATER (ft) : # HOURS SINCE DEWATERING : <br /> 2 <br /> p SAMPLING METHOD : OBSERVATION*: <br /> STOCKPILE#1 : 50 Cubic Yards COVERED : El YES XNO SAMPLE # SP - 1 SAMPLE # SP -2 <br /> STOCKPILE#2 : Cubic Yards COVERED : I.] YES El NO SAMPLE # SAMPLE # <br /> OTHER SAMPLES : <br /> LABORATORY: PACE ANALYTICAL NATIONAL CENTER SAMPLER' S NAME : Sarah Winn <br /> CLOSURE IN PLACE : BACKFILL MIXTURE : VOLUME : <br /> SITE MAP ATTACHED** : ® YES ❑ NO <br /> EH 23-0043 (Rev 03/04/15) IMPORTANT NOTES : Complete one form for each tank removed <br /> * Include all comments/observations ** Site Map Required <br /> See attached pipe sample continuation page <br />