Laserfiche WebLink
Time In: <br /> Time Out: <br /> Q�rN San Joaquin County <br /> z� Environmental Health Department <br /> _ 1868 East Hazelton Avenue, Stockton, CA95205-6232 <br /> �... �; Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sjgov.org/ehd <br /> 4�/Fp,Ra <br /> Underground Storage Tank Program Service Request Inspection Report <br /> Name of Facility: Date: 04/04/2016 <br /> Address: 1833 W KETTLEMAN LN, LODI 95240 <br /> Requestor: iN Telephone: <br /> Program Element: 2304 - UST REMOVAL Request#: SR0074397 <br /> Inspection Type: 134 - UST REMOVAL INSPECTION <br /> Onsite Service Technician: ICC Service Tech/Installer Exp. Date: <br /> Manufacturer training: <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> On site to conduct a UST removal inspection and witness required sampling for the following tanks: <br /> Tank 439-0520795 350 gallon gasoline tank. <br /> Tank#39-0520796 550 gallon gasoline tank. <br /> The tanks were triple rinsed and inerted with 104 pounds of dry ice. <br /> The lower explosive limit for both tanks was 0%. <br /> The oxygen level for the 350 gallon tank was 0.6% <br /> The oxygen level for the 550 gallon tank was 0.8% <br /> Jamie Thorpe had copies of permits from the City of Lodi and City of Lodi Fire Department for the removal of the USTS. <br /> The rinsate was left on site in a 55 gallon drum labeled as hazardous waste. <br /> The tanks and associated piping were removed by Jim Thorpe Oil, Inc. <br /> The following information must be submitted within 30 days after the UST removal date: <br /> a. Analytical results: only results that come directly from a third party California certified laboratory with affixed chain of custody <br /> will be accepted by EHD. <br /> b. UST Tracking Record Sheet and/or Tank and piping Hazardous Waste Manifest <br /> c. Tank Closure Certification Form(DTSC Form 1249). <br /> d. Hazardous Waste Manifest for rinsate and residual product. <br /> e. Backfill Excavation Certificate. <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: �il�'LAtlt'--0 '� � 4 aU►t(3; Name and Title: J1Vtn �t . T+� <br /> EH Specialist: ARIS VELOSO Phone: (209) 468-3453 <br /> SR0074397 SC134 04/04/2016 <br /> EHD 23-01 Rev.06/30/15 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />