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INSTALL_2022
Environmental Health - Public
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2300 - Underground Storage Tank Program
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PR0518288
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INSTALL_2022
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Entry Properties
Last modified
1/18/2023 9:33:30 AM
Creation date
5/31/2022 1:10:56 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
INSTALL
FileName_PostFix
2022
RECORD_ID
PR0518288
PE
2351
FACILITY_ID
FA0013810
FACILITY_NAME
COSTCO WHOLESALE #658
STREET_NUMBER
3250
Direction
W
STREET_NAME
GRANT LINE
STREET_TYPE
RD
City
TRACY
Zip
95377
CURRENT_STATUS
01
SITE_LOCATION
3250 W GRANT LINE RD
P_LOCATION
03
QC Status
Approved
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SJGOV\kblackwell
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EHD - Public
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Page 2 of 4 <br /> no% LEAK DETECTION <br /> T E C H N O L O G I E S irrc <br /> Providers for MDleak° MSleako DPleako, MCleak°and <br /> PHDleak° Testing Technologies <br /> 2765 East Wieding Road ❑ Tucson, AZ 85706 ❑ Phone 855-255-5325 ❑ FAX: 1-520-509-3720 <br /> Facility Certification CONFIDENTIAL <br /> Test Type: California ELD New Construction Test <br /> Facility Name: Costco#658 Job#: 4869 <br /> Prepared For: Jones Covey Group Inc. PO#: <br /> Site Address: 3250 W Grant line Road <br /> City: Tracy <br /> State and Zip: CA 95377 <br /> Start Date: 8/24/2022 End Date: 8/26/2022 <br /> SYSTEM T1-87 T2-87 T3-87 T4-91 VR <br /> Tank Volume in Gallons: 12000 12000 12000 20000 <br /> UST Manufacture: CSI CS1 CSI CSI <br /> Type of Interstice: Dry Dry Dry Dry <br /> Depth To Top Tank: NA NA NA NA <br /> Tank Diameter: NA NA NA NA <br /> Depth of Liquid Within Tank: NA NA NA NA <br /> Depth to Ground Water: <br /> Tank Sump Boots Turbine <br /> Component Manufacture: <br /> UDC/Dispensers Information <br /> Number of Dispensers: 12.00 0 0 0 <br /> Manufacture: <br /> Shear Valve Manufacture: <br /> Containment Boots: <br /> Piping Information Manufacture <br /> Product Lines: Smith <br /> Vapor Return/Vent: Smith <br /> Flex: <br /> Spill Buckets: <br /> EVR: <br /> Certifying Field Technician: Ben Getz State Lic.#: #21-1772 <br /> Certification Leak Rate: 0.005.gph / <br /> a <br /> Certifying Technician Signature: Date: 8/26/2022 <br /> This is a statement to confirm that the components listed above, at the time of testing, have been tested to a leak <br /> sensitivity listed above by using one or more of the following DPleako, MDleak°, MCleak and PHDleak° EPA aproved <br /> Methods. These Methods are the most versatile and comprehensive testing procedures offered to the petroleum <br /> industry. All petroleum owners and contractors which utilize the DPleak°, MDleak°, MCleak, and PHDleak° Method can <br /> be assured that their facility has passed the Nation's highest standard in preventative leak detection. <br /> I declare under penalty of perjury that I am a licensed tester in one of the above methods listed by the National <br /> Workgroup on Leak Detection Evaluations (NWGLDE) organization and that the information contained in this report is <br /> true and correct to the best of my knowledge. <br /> If you have any questions on the testing please do not hesitate to call. @ 855-255-5325. <br /> Office use only <br /> Statement Confirmed by: Date: 8/29/2022 <br />
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