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0 0 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> UST/PIPING CLOSURE INSPECTION FORM <br /> SITE NAME: Thrifty Oil Co. #171 (formerly Spirit Gasoline0 SR#: 0067786 <br /> ADDRESS: 1250 N Wilson CITY: Stockton <br /> OWNER NAME: Best California Gas., LTD PHONE: 562-921-3581 <br /> CONTRACTOR: Tafo aAssociates `, PHONE: 909-606-6322 <br /> FIRE PERMIT#: Stockton Fire Department 8/13/13 (:,TANK#39 r ©L 05-14% <br /> ❑ PIPING REMOVAL UST REMOVAL ❑ CLOSUR ❑ TEMPORARY CLOSURE <br /> INSPECTOR: Jeffrey Wong DATE: ::CLA <br /> R RINSED: OYES ❑ NO METHOD: 4; ^SQ AMOUNT: 00 <br /> � <br /> N RINSATE DISPOSAL SITE: �D t)I ` r ✓�Qy d <br /> S MANIFEST#: l O t{Q $ Cj SS�" OTHER TRACKING#: <br /> E <br /> I V <br /> q PURGED: ❑YES ❑ NO METHOD: '0v , C-t AMOUNT USED: <br /> P <br /> e READINGS AT REMOVAL: L.E.L.: 02: SW//COMMENTS': <br /> C TANK MATERIAL: 2LSTEEL ❑ FIBERGLASS ❑ OTHER TANK SIZE oor) _ <br /> 0 TANK CONDITION: GOOD ❑ POOR ❑ HOLES Comments*: <br /> S PIPE MATERIAL: �t STEEL ❑ FIBERGLASS ❑ OTHER TOTAL LENGTH OF PIPING <br /> T PIPE CONDITION: ❑ GOOD ❑ POOR ❑ HOLES Comments*: <br /> DEPTH SOIL TYPE OBSERVATION* SAMPLE# <br /> T N >w S\\ tJ) 0( No -W,1 <br /> A SPM sI VP <br /> W op ('01W 1410 — —t S <br /> N o n d D iz 0 w Tg I — <br /> K <br /> EXCAVATION SIZE: X 7371A X t$ <br /> L O rear oyn <br /> S DEPTH SOIL TYPE OBSERVATION* SAMPLE# <br /> A P <br /> M I <br /> P P <br /> L E <br /> I TRENCH SIZE: X X <br /> N uap* man mm� <br /> G H DEPTH TO GROUNDWATER: FT #HOURS SINCE DEWATERING: <br /> 2 <br /> 0 SAMPLING METHOD: OBSERVATION*: <br /> STOCKPILE#1: Cubic Yards COVERED: ❑YES ❑ NO SAMPLE# SAMPLE# <br /> STOCKPILE#2: Cubic Yards COVERED: OYES ❑ NO SAMPLE# SAMPLE# <br /> OTHER SAMPLES: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE: BACKFILL MIXTURE: VOLUME: <br /> SITE MAP ATTACHED**:A 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 />