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SAN JOAQUIN CANTY ENVIRONMENTAL HEAL 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 580115819 <br />® PIPING REMOVAL ® UST REMOVAL ❑ CLOSURE IN PLACE ❑ TEMPORARY CLOSURE <br />INSPECTOR: JEFFREY WONG DATE: 3/4/2014 <br />R <br />RINSED:YES ❑ NO <br />METHOD: )r; <br />AMOUNT: i <br />I <br />N <br />RINSATE DISPOSAL SITE: <br />EMANIFEST <br />v <br />A <br />P <br />#: 0023 OTHER TRACKING M <br />PURGED:,KYES ElNO METHOD: �i ZC '( <br />AMOUNT USED: 1(20 <br />R <br />READINGS AT REMOVAL: <br />- <br />L.E.L.: 02: COMMENTS*: <br />C <br />MATERIAL: ❑ STEEL ® FIBERGLASS ❑ OTHER TANK SI E: 1,000 (Regular)0 <br />[TANK <br />CONDITION: ZGOOD ❑ POOR [HOLES COMMENTS*: f 2pjt .� /. tgC"vqNg <br />MATERIAL: ❑ STEEL FIBERGLASS El OTHER <br />TOTAL LENGTH OF PIPING: <br />T <br />PIPE CONDITION: ❑ GOOD ❑ POOR ❑ HOLES COMMENTS*: <br />DEPTH <br />SOIL TYPE S OBSERVATION* <br />S PLE # <br />T <br />) <br />ca<t�C <br />T tri% <br />A' <br />Y 1' 1 OrR <br />N <br />K <br />r C t' (R— I b <br />EXCAVATION SIZE (length x width x depth): X S-tf X 16 <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 />,rry� r <br />TRENCH SIZE (lengthxwidthxdeph): X X �J# yC� ,z 4- 1L10, cernct <br />G <br />H <br />DEPTH TO GROUNDWATER: ft <br />#HOURS SINCE DEWATERING: <br />2 <br />0 <br />SAMPLING TROD: <br />OBSERVATION*: <br />STOCKPILEV ( So Cubic Yards COVERED: ❑YES F_] NO SAMPLE#sI SAMPLE# 5f Z- 5P3 sPq- <br />STOCKPILE ubic Yards COVERED: [:]YES ❑ NO SAMPLE# SAMPLE# I rfa l <br />OTHER SAMPLES: <br />LABORATORY: Argon <br />SAMPLER'S NAME: Groundzero <br />CLOSURE IN PLACE: <br />BACKFILL MIXTURE: <br />VOLUME: <br />SITE MAP ATTACHED**: YES FIND <br />EH 23-M3 (Rev 5/2212007) IMPORTANT NOTES: Complete one form for each tank removed <br />(� <br />*Include all commentsiobservations "Site Map Required <br />rS� <br />