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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: Tafoya Associates PHONE: 909-606-6322 <br /> FIRE PERMIT#: Stockton Fire Department 8113113 <br /> 'PIPING REMOVAL ❑ UST REMOVAL ❑ CLOSURE IN PLACE ❑ TEMPORARY CLOSUR <br /> INSPECTOR: Jeffrey Wong DATE: ft q 1 20 <br /> R RINSED: ❑YES ❑ NO METHOD: AMOUNT: <br /> I y <br /> N RINSATE DISPOSAL SITE: <br /> S <br /> E MANIFEST#: OTHER TRACKING#: <br /> v <br /> A PURGED: L3 YES ❑ NO METHOD: AMOUNT USED: <br /> P <br /> R READINGS AT REMOVAL: L.E.L.: 02: COMMENTS*: <br /> C TANK MATERIAL: ❑ STEEL ❑ FIBERGLASS ❑ OTHERTANK SIZE <br /> 0 TANK CONDITION: ❑ GOOD ❑ POOR ❑ HOLES Comments*: <br /> N <br /> S PIPE MATERIAL: ❑ STEEL gFIBERGLASS ❑ OTHER TOTAL LENGTH OF PIPING <br /> T PIPE CONDITION: ❑ GOOD ❑ POOR ❑ HOLES Comments*: <br /> DEPTH SOIL TYPE OBSERVATION* SAMPLE# <br /> T <br /> A <br /> N <br /> K <br /> EXCAVATION SIZE: X X <br /> i O Wft NP <br /> S DEPTH SOIL TYPE OBSERVATION* SAMPLE# <br /> A P G 0. D O l J " <br /> M I PZ <br /> P PN r <br /> L E �p �� 1.)r <br /> RENCHSIZE: X X� <br /> N wo D.PM <br /> G H DEPTH TO GROUNDWATER: FT #HOURS SINCE DEWATERING: <br /> 2 <br /> 0 SAMPLING METHOD: OBSERVATION*: <br /> STOCKPILE#t: Cubic Yards COVERED: OYES ❑ NO Si <br /> STOCKPILE#2: Cubic Yards COVERED: OYES ❑ NO Si GREG SOUTHERN <br /> OTHER SAMPLES: � Cell:(714)580-9580 <br /> LABORATORY: S TANK CLEANING EXPERTS <br /> CLOSURE IN PLACE: BACKFILL MIXTURE: Industrial and Hazardous Waste Services <br /> SITE MAP ATTACHED**: ❑YES ❑ NO (310) 523-4430•FAX(310) 523-1518 <br /> 406 E.Alondra Blvd.,Gardena,CA 90248-2902 <br /> gmg@adamaeervicea.com•w adamaeervicea.com <br /> EH 23-M3(Rev 5/2212007) IMPOI <br /> *Include all commentslobservatons-* 8itefap-RequirecE <br />