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SAN JOAQUIN COUNTY ENVIRONMENTAL HEAPH DEPARTMENT <br />UST/PIPING CLOSURE INSPECTION FORM <br />SITE NAME: SJ REGIONAL TRANSIT SR#: 0068638 <br />ADDRESS: 1533 E. LINDSAY CITY: STOCKTON <br />OWNER NAME: SJ REGIONAL TRANSIT PHONE: 467-6671 <br />CONTRACTOR: TERRACO (SR REQUESTOR) / JIM THORPE (REMOVAL) PHONE: 847-906-5019 <br />FIRE PERMIT #: COS FIRE DEPART 1-13-14 TANK # 39 580115815 <br />❑ PIPING REMOVAL ® UST REMOVAL ❑ CLOSURE IN PLACE ❑ TEMPORARY CLOSURE <br />INSPECTOR: JEFFREY WONG DATE: 3/4/2014 <br />R <br />I <br />RINSED: YES ❑ NO <br />METHOD: D --rV^ <br />AMOUNT: l�s� <br />N <br />RINSATE DISPOSAL SITE: <br />E <br />E <br />MANIFEST <br />�© <br />Qp Z3 � g� <br />OTHER TRACKING #: <br />V <br />P <br />PURGED: RYES ❑ NO <br />METHOD: f Z�Q <br />AMOUNT USED: <br />R <br />READINGS AT REMOVAL: <br />L.E.L.: C 02: COMMENTS*: <br />C <br />TANK MATERIAL: ❑ STEEL ® FIBERGLASS ❑ OTHER <br />TANK SIZE: 20,000 (Diesel) <br />O <br />TANK CONDITION: ❑GOOD ❑ POOR J4HOLES COMMENTS*: (SrR Cf- 00 VV4ESt @AJ _Cir' Jae i,L <br />N <br />S <br />PIPE MATERIAL: ❑ STEEL EA FIBERGLASS [:]OTHER <br />TOTAL LENGTH OF PIPING: <br />T <br />PIPE CONDITION: E] GOOD [_1 POOR ❑ HOLES COMMENTS*: ChuS �dd 12+NeJic� aIwZi d(Mp <br />DEPTH SOIL TYPE <br />OBSERVATION* <br />SAMPLE <br />T <br />Ell%V t a.4 <br />N, O lor z5(d lor <br />-r (-W <br />A-4 <br />C C <br />AJ 6 a r Z A S <br />'e��1' <br />N <br />La <br />eJo l diS�Ia ra'iml ` <br />1 .— = <br />K <br />EXCAVATION SIZE (length x width x depth): S X X <br />t <br />S <br />DEPTH <br />SOIL TYPE <br />OBSERVATION* <br />SAMPLE # <br />A <br />P <br />M <br />I <br />P <br />P <br />L <br />E <br />I <br />N <br />TRENCH SIZE (length x width x depth): X X A)? �Y* yv- ka_ 1-n Cowl <br />G <br />H <br />DEPTH TO GROUNDWATER: ft <br /># HOURS SINCE DEWATERING: <br />2 <br />O <br />SAMPLING METHOD: <br />OBSERVATION*: <br />STOCKPIL : 50 Cubic Yards COVERED: ❑ YES ❑ NO SAMPLE#SJol SAMPLE # S p {p SP 11 ISM <br />STOCKPILE" Cubic Yards COVERED: ❑ YES ❑ NO SAMPLE # SAMPLE It .1' �j <br />OTHER SAMPLES: <br />LABORATORY: Argon <br />fl <br />SAMPLER'S NAME: Groundzero <br />CLOSURE IN PLACE: <br />BACKFILL MIXTURE: <br />VOLUME: <br />SITE MAP ATTACHED**: ES ❑ 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 />