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SAN" J D�l+ �� I 1411" Environmental Health Department <br /> COUNTY— <br /> Underground <br /> �l O U N T -- <br /> Underground Storage Tank Program Inspection Report <br /> Facility Name: Facility Address: Tileptember <br /> ate: <br /> COSTCO WHOLESALE#658 3250 W GRANT LINE RD TRACY 26 2019 <br /> The monitoring system certification was conducted on 9/26/2019 and was not witnessed by EHD. EHD did not <br /> witness the complete inspection. Looked inside all sumps and UDCs. Verified sensor locations and piping <br /> communication. No liquid noted. An inspection checklist was provided to the facility operator on the day of <br /> inspection. The EHD has written the complete report which replaces the initial checklist. <br /> Complete and submit a copy of the Return to Compliance Certification form to the EHD with a statement <br /> documenting the corrective actions that have been or will be taken for each violation, and any supporting <br /> paperwork, within 30 days of receiving the complete inspection report. <br /> Documents provided during inspection: <br /> -Return to compliance certification <br /> -Corrective Action Statement <br /> -EHD class schedule <br /> AFTER THE COMPLIANCE DATE, EHD WILL BILL FOR ALL TIME AND ACTIVITIES ASSOCIATED WITH BRINGING THIS <br /> FACILITY BACK INTO COMPLIANCE. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> Received by: Date: October 18, 2019 Inspector: Inspector Phone: <br /> Printed Name and Title: SHEWIT WOLDEAREGAY, EH Specialist (209)468-0216 <br /> Mailed, <br /> FA0013810 PRO518288 SCO01 09/26/2019 <br /> EHD 23-01 Rev.08/27/2019 Page 5 of 5 Underground Storage Tank Program OIR <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />