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r: � I I I Environmental Health Department <br /> Y SA N U <br /> rk.1 wti COUNTY Time In: <br /> Time Out: <br /> Greorness grows here, <br /> Underground Storage Tank Program Service Request Inspection Report <br /> Name of Facility: COSTCO WHOLESALE#658 Date: 01/18/2022 <br /> Address: 3250 W GRANT LINE RD ,TRACY 95377 <br /> Requestor: JAMES ALEXANDER,WAYNE PERRY INC Telephone: (916)646-9680 <br /> Program Element: 2308-UST RETROFIT Request#: SR0083166 <br /> Inspection Type: 298-UST RETROFIT REPAIR INSPECTION <br /> Onsite Service Technician: Nicholas Harvey ICC Service Tech/Installer Exp. Date: 12/03/2022 <br /> Manufacturer training: Icon, 11/12/23; Incon, 07/28/23 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> On site for the following: <br /> 1. Conducted visual inspection of penetration fittings/piping within UDCs 1/2, 3/4, and 11/12 for any leaks. <br /> 2. Witnessed secondary containment testing on UDCs 1/2, 3/4, and 11/12, and the 91 product piping. <br /> All passed. <br /> To minimize person to person contact EHD is choosing to write the name of the person receiving the report instead of having <br /> 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: Emailed to James Alexandar,Wayne <br /> EH Specialist: ELIANNA FLORIDO Phone: (209)616-3050 <br /> FA0013810 SR0083166 SC298 01/18/2022 <br /> EHD 23-01 Rev.09/16/2020 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />