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9 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 Califomia Gas., LTD PHONE: 562-921-3581 <br /> CONTRACTOR: Tafo a Associates PHONE: 909-606-6322 <br /> FIRE PERMIT#: Stockton Fire Department 8113/13 r 0lTANK#39 Q 5-()S k3,5- <br /> ❑ PIPING REMOVAL UST REMOVAL ❑ CLOS ACE ❑ TEMPORARY CLOSURE I ' <br /> INSPECTOR: Jeffrey Wong DATE: --,SA✓` Q J z- y— <br /> R RINSED: ❑YES ❑ NO METHOD: ( �S� AMOUNT: .7000 s <br /> I <br /> N RINSATE DISPOSAL SITE: Ve myxy\p �Gt i/ V n9 s 41r /Igi{t1t5 Sery ce,5 <br /> E MANIFEST#: Of OL.` Sly- OTHERTRACKINGM <br /> HRRPURGED: J-YYES ❑ NO METHOD: AMOUNT USED: 360 1READINGS AT REMOVAL: L.E.L.: 02: 34COMMENTS*: <br /> C TANK MATERIAL: STEEL ❑ FIBERGLASS ❑ OTHER TANK SIZE ( X O O <br /> 0 TANK CONDITION: GOOD ❑ POOR ❑ HOLES Comments*: <br /> N <br /> S PIPE MATERIAL: K STEEL ❑ FIBERGLASS ❑ OTHER TOTAL LENGTH OF PIPING <br /> T PIPE CONDITION: ❑ GOOD ❑ POOR ❑ HOLES Comments*: <br /> DEPTH SOIL TYPE OBSERVATION* SAMPLE# <br /> T S�W N0 40-r -' to <br /> A s o aor u, L Lo oYA <br /> N Z s u �r v ji <br /> K <br /> EXCAVATION SIZE: S-4 X X <br /> wean vnau <br /> gle <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 HDEPTH TO GROUNDWATER: FT #HOURS SINCE DEWATERING: <br /> 2 <br /> p 1 SAMPLING METHOD: OBSERVATION*: <br /> STOCKPILE#1: Cubic Yards COVERED: OYES ❑ NO SAMPLE# SAMPLE# <br /> STOCKPILE#2: Cubic Yards COVERED: OYES O NO SAMPLE# SAMPLE# <br /> OTHER SAMPLES: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE: BACKFILL MIXTURE: VOLUME: <br /> SITE MAP ATTACHED**:?d YES ❑ NO <br /> EH 23-0043(Rev 5/2212007) IMPORTANT NOTES: Complete one form for each tank removed <br /> *Include all commentslobservations **Site Map Required <br />