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SANIdOAQUIN <br />-COUNTY <br />Grrarness grows here. <br />Environmental Health Department <br />Service Request Inspection Report <br />Name of Facility: Costco Gasoline <br />Date: 11/05/2024 <br />Address: 3250 W GRANT LINE RD, TRACY 95377 <br />Requestor: Albert Barajas <br />Telephone: (909)-213-5266 <br />Program Element: 2308 - UST RETROFIT <br />Request #: SR2400586 <br />Inspection Type: 4320 - UST RETROFIT REPAIR INSPECTION <br />Onsite Service Technician: Keith Henderson <br />ICC Service Tech/Installer Exp. Date: 06/16/2025 <br />Manufacturer training: Bravo, 12/10/24 <br />OVERALL INSPECTION NOTES AND COMMENTS <br />NOTES <br />- Verified repairs- penetration fittings in UDC 13/14. <br />- Witnessed one hour integrity testing of UDC 13/14 <br />-Verified and witnessed pink brine addition in UDC 13/14. <br />All passed. <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: <br />EH Specialist <br />PAUL NSO <br />Name and Title: Global Sustainabilitv and ComDliance <br />Phone: (209) 616-3049 <br />FA0013810 SR2400586 SC4320 11/05/2024 <br />EHD Rev. 09/16/2020 Page 1 of 1 Service Request Inspection Report <br />