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SAN J0AQUIN - C C7 4.1 1'•I i� ,I. Environmental Health Department It FA001e72f PR0527829 SC007 05/Oa/20 Page 1 Facility Name: Facility Phone: Date; Costco Wholesale #1031 (209) 825-8200 May 08, 2024 Factilly Address: CERS ID; 2440 DANIELS ST, MANTECA, CA 95337 10146143 Inspection Contact:Tltla: 468-3420 l Phone: GSC Environmental Contact (425) 427-7862 Inspection Type:Program: ROUTINE INSPECTION - Operating Permit 2351 -UST FACILITY - 2481 COMPLIANT Consent For: Consent Given 9y: © Inspection 0 Photos 21 Samples Hector Ruiz, Attendant Service Technician Onslle: Exp, Dale: Designated Operator; Exp. Dale: Isaac Anderson 10/17/2024 Fernando Solis 04/05/2025 Service Technician Manufacturer's Training: FF, 04/22/26; OPW, 04/22126; VR, 8/2912024; VMI, 04/18/25 CCR= Tile 23 California Coda of Regulations HSC= Health and Safely Code CFR= Cade of Federal Regulations EHD= Environmental Health Department V=Molauon R=Repeal violation COS= Consoled an site doing lnspeellon o V o R o COS IDI HSC 25284; CCR Failure to obtain a permit to operate from the EHD Including but not limited to unpaid permit fees 271l(d) 102 CCR 2711 Fallure to submit a complete and accurate application for a permit to operate a UST u V o R o COS 103 CCR 2636(1), 2036(c)(2) Fallure to submit the UST Certifuttion of InelallallcnlModlBcailon a V d R o COS 104 CCR 2632(d)(1), Failure to submit a complete and accurate UST Monitoring Plan o V a R o COS 2834(d) 105 CCR 2632(d)(2), Failure to submit a complete and accurate UST Response Plan a V o R a COS 2834(a) 106 CCR 2632(d), 2641(h) Failure to submit and maintain a current facility plot plan I As map o V a R o COS 107 HSC 25282.2; CCR Failure to submit and maintain complete and current financial responstbtitty documents o V o R o COS 2711 a 11 108 CCR 2620(b); HSC Failure to Implement ormaintaln a written agreement between the UST owner and operator n V o R o COS 262a4 a 3 109 CCR 2716(a)(1)(D), Failure to submit "Designated Underground Storage Tank Operator Identification Farm" within 30 days n V o R o COS 2715 a 3 110 CCR 2715(ax1)(A), Failure to submit the "Underground Storage Tank Statement of Understanding and Compliance Farm? o V o R o COS 2716 a 2 111 CCR 2837, 2638(e), Felled to notify the EHD 48 hours pdorto conducting testing o V o R o COS 2043 112 CCR 2638, 28418)5 Failure to have property qualified service technician lest leak detection equipment every 12 months o V a R a COS 2715 113 CCR 2837(a -d), 2712(b) Failure to conduct secondary containment testing o V n R o COS 1F 114 CCR 2636(8(3), 2043(c) Failure to perform line Integrity teat every 12 months or wkhin 30 days of repair of primary pipe o V o R u COS 3 115 CCR 2638(c), 2838(d) Fallure to submit "Monitoring System Certification Form` wllhin 30 days of completion of the leak o V a R o COS 116 CCR 2637.1(d), Fallure to submit the "Split Container Testing Report Form° within 30 days o V o R o COS 2637,1(e) 117 CCR 2637(0)1 2637(0 Failed to submit "Secondary Containment Testing Report Form" Albin 30 days oiler the test u V o R o COS 118 CCR 2837.2(d&e), Failure to submit the "Overfill Prevention Equipment Inspection Report Farm" wllhin 30 days o V o R o COS 2666 a&b 119 CCR 2663, 2712(6)(6) Failure to comply with tank lining certificetlon, testing, Inspection, and record requirements o V a R o COS 120 CCR 2631, 2640.1, Fallure to submit and/or maintain documentation regarding compatibility for UST system components o V o R o COS 2885,2711 24 END 23-07 ReV, 12/06/2021 Page 1 of 5 UntlergroUnd Storage Tank Program OIR 1668 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 l F 209 4G4-0138 � www.sjgov.orglEHO