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SAN JOAQUIN CtrUNTY ENVIRONMENTAL HEA=-CH DEPARTMENT <br /> UST/PIPING CLOSURE INSPECTION FORM <br /> SITE NAME: AAL 3°I 6n" per! 6Sk#L-Q, TPJ Ue S }Ane*k SR#: S'2- <br /> ADDRESS: <br /> 'ZADDRESS: 7..Lg-Cj Y. Fi �S'�� <br /> (. I�D/ �Y/�La �� CITY: f4 <br /> OWNER NAME: O`!N f 2 PHONE:�ua )e lwo <br /> CONTRACTOR: pi 2 Of-L . rj( PHONE: ?Z 07- �-yg/ <br /> FIRE PERMIT#: GI L I I b SpG'GJ^'b W" I '(`4410 3 TANK#39 Q,�_/ fl % <br /> ❑ PIPING REMOVAL '�it UST REMOVAL ❑ CLOSURE IN PLACE ❑ TEMPORARY CLOSURE <br /> INSPECTOR: /Z VO- P/141� DATE: G 7 G <br /> R RINSED:'KYES ❑ NO METHOD: —rj-4 Lg 2klr AMOUNT: / ,yL <br /> N RINSATE DISPOSAL SITE: 2 u cr b 41 yL C D <br /> S <br /> E MANIF�b '�3 S ��� Ll FLS OTHER TRACKING#: <br /> A PURGED: YES LINO METHOD: DrLI rZ^ AMOUNT USED: <br /> P <br /> R READINGS AT REMOVAL: L.E.L.:O,p 02: 3,/, COMMENTS': F)F T^,50�_ pal <br /> C TANK MATERIAL: STEEL ❑ FIBERGLASS ❑ OTHER TANK SIZE )GT3O 54-<_ <br /> O TANK CONDITION: Ll GOOD Ll POOR HOLES Comments*: Mp <br /> N pr h ebb 1. yb��. C.*-L. <br /> S PIPE MATERIAL: ❑ STEEL ❑ FIBERGLASS ❑ OTHER TOTAL LENGTH OF PIPING <br /> T PIPE CONDITION: ❑ GOOD ❑ POOR ❑ HOLES Comments': <br /> DEPTH SOIL TYPE OBSERVATION* SAMPLE# <br /> T 0I M`-'1 tJU D O �� br K v W W <br /> A D oyL -r, 7 S C.b I or f7ek TK /coo 1-1 F <br /> N <br /> K 4Aw_ 1 <br /> EXCAVATION SIZE: AD=XpLi X VI <br /> wft D� <br /> S DEPTH SOIL TYPE OBSERVATION` SAMPLE# <br /> A P <br /> M I <br /> P P <br /> L E <br /> TRENCH SIZE: X X <br /> N <br /> G H DEPTH TO GROUNDWATER: FT #HOURS SINCE DEWATERING: <br /> 2 <br /> 0 1 SAMPLING METHOD: OBSERVATIO '• <br /> STOCKPILE#1: Cubic Yards COVERED: ❑YES X NO SAMPLE# SAMPLE# <br /> STOCKPILE#2: Cubic Yards COVERED: L3YES NO SAMPLE# 61C10 SAMPLE <br /> OTHER SAMPLES: <br /> LABORATORY: n G SAMPLERS NAME: Ckr(/1.i <br /> CLOSURE IN PLACE: BACKFILL MIXTU E: VOLUME: <br /> SITE MAP ATTACHED": YES ❑ NO <br /> EH 23-0043(Rev 5/2212007) IMPORTANT NOTES:Complete one form for each tank removed <br /> 'Include all commentsiobservations "Site Map Required <br />