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SANOAQU I N Environmental Health Department <br /> COU NI T Y I Y Time In: <br /> + _,fr Time Out: <br /> . •- Greotr+ess �row3 here, <br /> Underground Storage Tank Program Service Request Inspection Report <br /> Name of Facility: COSTCO WHOLESALE#658 Date: 08/30/2022 <br /> Address: 3250 W GRANT LINE RD ,TRACY 95377 <br /> Requestor: M.ALEXIA INIGUES, BARGHAUSEN CONSTULTING ENGINEERS INC Telephone: (425)251-6222 <br /> Program Element: 2303-UST/PIPING INSTALLATION Request#: SR0083815 <br /> Inspection Type: 131 -UST INSTALLATION INSPECTION <br /> Onsite Service Technician: Issiac Anderson ICC Service Tech/Installer Exp. Date: 09/10/2022 <br /> Manufacturer training: opw, 06/02/24;VR, 08/29/24;VMI, 04/18/23 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> On site to observe: <br /> -Verification of leak monitoring communication for all installed vacuum, pressure or hydrostatic components. <br /> -Verification of the dispenser footprint contained by the UDC's. <br /> -- Received passing ELD test results. <br /> -Verification of VPH components installation. <br /> -Verification of overfill prevention installation and functionality. <br /> -Verification of spill bucket installation and functionality. <br /> -Confirmed monitoring system functionality. <br /> -Site is approved to receive fuel. <br /> Note: <br /> Premium 91 tank contains 7535 gallons of fuel. Fuel was added on 8/29/2022. Fuel delivery had not been approved till as of <br /> 8/30/2022. Leak detector testing was completed on the 91 tank 8/30/22. Site is approved to receive fuel. <br /> Site is not approved to operate. <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 report to; Joseph Malcolm, S <br /> EH Specialist: FREDERICK ERNEST Phone: (209)616-3026 <br /> FA0013810 SR0083815 SC131 08/30/2022 <br /> EHD 23-01 Rev.09/16/2020 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />