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i �� I I I AI Environmental Health Department <br /> YSA N U N <br /> rT�z wti COUNTY Time In: <br /> Time Out: <br /> Greotr+ess �rGws 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 CONSULTING ENGINEERS INC Telephone: (425)251-6222 <br /> Program Element: 2308-UST RETROFIT Request#: SR0084603 <br /> Inspection Type: 001 -ROUTINE INSPECTION-Operating Permit <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 /> -Monitor system functionality <br /> -Leak detector testing <br /> -Verification of overfill protection on the three unleaded 87 gas tanks <br /> -Spill container installation and functionality <br /> -Secondary containment testing. <br /> Unleaded 87 and additive UST system are approved to receive fuel. <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 /> SR0084603 SCO01 08/30/2022 <br /> EHD 23-01 Rev.09/16/2020 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />