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COMPLIANCE INFO_2023
Environmental Health - Public
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EHD Program Facility Records by Street Name
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GRANT LINE
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2300 - Underground Storage Tank Program
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PR0518288
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COMPLIANCE INFO_2023
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Entry Properties
Last modified
12/17/2025 2:44:35 PM
Creation date
1/13/2023 9:39:51 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2023
RECORD_ID
PR0518288
PE
2351 - UST FACILITY - 2481 COMPLIANT
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
Active, billable
QC Status
Approved
Scanner
SJGOV\kblackwell
Supplemental fields
Site Address
3250 W GRANT LINE RD TRACY 95377
Tags
EHD - Public
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U LTRAZOL®GA9058 <br />Manufacturer's Affirmative Statement of Compatibility <br />(As required by California Code of Regulations section 2631(k)) <br />As required <br />by Federal Regulation CFR <br />Title 40, Chapter 1, Subchapter 1, Part 280.32 b 91 ii <br />Manufacturer(s) <br />(including prior Model <br />marketed names) <br />Component <br />p <br />Type <br />(i.e. pipe, <br />tank, etc. <br />Current <br />UL <br />Standard <br />Listing <br />Unique <br />Years of Identifiers for <br />Manufacture Sizes Field Evaluation <br />(i.e. color, material) <br />Blend <br />Concentration <br />Supporting <br />Test Data & <br />Documents <br />Attached <br />Yes/No <br />Petro Clear 40530P <br />Filter <br />VXYV2 <br />Red Color <br />NA <br />NO <br />Petro Clear .75N1-12 <br />Adapter <br />=, <br />Black Color <br />NA <br />NO <br />1 declare, to the best of my knowledge and belief, that this <br />affirmative statement of compatibility and the information contained hr-trtn <br />iq�grue, <br />correct, and complete. <br />—_ <br />;;� <br />Kris Stanhope <br />Engineering Design Manager <br />Prt Name <br />Title <br />For tanks and piping please list only double wall products <br />(insert a company logo below if available) <br />Manufacturer: Champion Laboratories, Inc. <br />Corporate: Champion Laboratories, Inc. <br />l <br />Headquarters: <br />Address: 200 S 411 St. Albion, IL 62806 <br />^ <br />N <br />Phone: (618) 445-6011 <br />=, <br />C <br />Email: Kris.stanhope@champlabs.com <br />1 declare, to the best of my knowledge and belief, that this <br />affirmative statement of compatibility and the information contained hr-trtn <br />iq�grue, <br />correct, and complete. <br />—_ <br />;;� <br />Kris Stanhope <br />Engineering Design Manager <br />Prt Name <br />Title <br />-1�7 r <br />Manufacturer's Authorized Signature <br />2023 <br />Date <br />
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