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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> UST/PIPING CLOSURE INSPECTION FORM <br /> SITE NAME : COSTCO WHOLESALE #658 SR# 1 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 . 888-972-7581 <br /> FIRE PERMIT # : 435 TANK # 39 <br /> ® PIPING REMOVAL ❑ UST REMOVAL ❑ CLOSURE IN PLACE ❑ TEMPORARY CLOSURE <br /> INSPECTOR : Carol Presto DATE : 6/30/2022 <br /> R RINSED : ❑ YES ❑ NO METHOD : AMOUNT : <br /> I <br /> N RINSATE DISPOSAL SITE : <br /> S <br /> E MANIFEST # : OTHER TRACKING M <br /> RJA PURGED : ❑ YES F1NO METHOD : AMOUNT USED : <br /> P <br /> 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) : 24 <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 2 clay light brown , dry , no odors observed P-6 <br /> M 1 3 clay light brown , dry , no odors observed P-7 <br /> P P <br /> L E <br /> NTRENCH SIZE (length x width x depth) : 24 ft X 4 ft X 2 ft <br /> G H DEPTH TO GROUNDWATER (ft) : # HOURS SINCE DEWATERING : <br /> 2 <br /> 0 SAMPLING METHOD : OBSERVATION * : <br /> STOCKPILE#1 : Cubic Yards COVERED : ❑ YES ONO SAMPLE # SAMPLE # <br /> STOCKPILE#2 : Cubic Yards COVERED : ❑ YES [:] 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 />