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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> ct ( UST/PIPING CLOSURE INSPECTION FORM <br /> ,7 SITE NAME: Thrifty Oil Co #171 (formerly Spirit Gasoline() SR#: 0067786 <br /> t ADDRESS: 1250 N Wilson CITY: Stockton <br /> OWNER NAME: Best California Gas., LTD PHONE: 562-921-3581 <br /> CONTRACTOR: Tafo a Associates PHONE: 909-606-6322 <br /> FIRE PERMIT #: Stockton Fire Department 8/13/13 (B� <br /> TANK#39 <br /> ❑ PIPING REMOVAL JA UST REMOVAL ❑ CLOSURE IN PLACE ❑ TEMPORARY CLOSURE <br /> INSPECTOR: Jeffrey Wong DATE: J DLII `1 , Z�I <br /> R RINSED: 9 YES ❑ NO METHOD: /�jf - �� rIV AMOUNT: (; Iie�"' <br /> I <br /> N RINSATE DISPOSAL SITE: �eMe Nip V 6 <br /> EMANIFEST#: O f7 LtO 36q OTHER TRACKING#: <br /> A PURGED: YES ❑ NO METHOD: Pr �c AMOUNT USED: �'S() 6 <br /> P <br /> R READINGS AT REMOVAL: L.E.L.: 02* je, COMMENTS*: <br /> C TANK MATERIAL: V STEEL ❑ FIBERGLASS ❑ OTHER TANK SIZE I f* 00 <br /> 0 TANK CONDITION:-4 GOOD ❑ POOR ❑ HOLES Comments*: <br /> S PIPE MATERIAL: WSTEEL ❑ FIBERGLASS ❑ OTHER TOTAL LENGTH OF PIPING <br /> T PIPE CONDITION: ❑ GOOD ❑ POOR ❑ HOLES Comments*: <br /> DEPTH SOIL TYPE OBSERVATION* {m { SAMPLE# <br /> T tAjp Cp Y inn O 40 Y <br /> A <br /> N <br /> K <br /> EXCAVATION SIZE: X 3 X� f <br /> S DEPTH SOIL TYPE OBSERVATION* SAMPLE# <br /> A P <br /> M I <br /> P P <br /> L E <br /> tTRENCH : X X <br /> NL ' xw omn <br /> G HOUNDWATER: FT #HOURS SINCE DEWATERING: <br /> 2 <br /> 0 ETHOD: OBSERVATION*: <br /> STOCKPILE#1: Cubic Yards COVERED: OYES ❑ NO SAMPLE# SAMPLE# <br /> STOCKPILE#2: Cubic Yards COVERED: DYES ❑ NO SAMPLE# SAMPLE# <br /> OTHER SAMPLES: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE: I BACKFILL MIXTURE: VOLUME: <br /> SITE MAP ATTACHED**:jhYES ❑ NO <br /> EH 23-0043(Rev5/222007) .5�1` r f1 <Ja IMPORTANT NOTES:Complete one form for eac tank removed <br /> P% C,;"m s r r 0 of T / *Include all commentstobservations **Site Map Required <br />