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SAN JOAQUIN COUNTY ENVIRONMENTAL HEAL i H DEPARTMENT UST/PIPING CLOSURE INSPECTION FORM SITE NAME: SJ REGIONAL TRANSIT SR#: 0068638 ADDRESS: 1533 E. LINDSAY CITY: STOCKTON OWNER NAME: SJ REGIONAL TRANSIT PHONE: 467-6671 CONTRACTOR: TERRACO (SR REQUESTOR) / JIM THORPE (REMOVAL) PHONE: 847-906-5020 FIRE PERMIT #: COS FIRE DEPART 1-13-14 TANK # 39 580115820 ❑ PIPING REMOVAL ® UST REMOVAL ❑ CLOSURE IN PLACE ❑ TEMPORARY CLOSURE INSPECTOR: JEFFREY WONG DATE: 3/4/2014 R RINSED: $YES ❑ NO METHOD: AMOUNT: 450 I N RINSATE DISPOSAL SITE: E MANIFEST #: 2�6 OTHER TRACKINGM V A P PURGED: &YES ❑ NO METHOD: DRY ICE AMOUNT USED: �C)o R READINGS AT REMOVAL: L.E.L.: 02: COMMENTS*: C TANK MATERIAL: [-]STEEL ® FIBERGLASS [-]OTHER TANKSI E: 1,000 (ATF) -5 l} -F 0 TANK CONDITION: VZOOD ❑ POOR 14 HOLES COMMENTS*: (q Q pvt f isrtt C 4y axegy44, N g PIPE MATERIAL: ❑ STEEL YFIBERGLASS ❑ OTHER I TOTAL LENGTH OF PIPING: T PIPE CONDITION: ❑ GOOD ❑ POOR ❑ HOLES COMMENTS*: A&W0 DEPTH SOILTYPE OBSERVATION* SAMPLE# T V Y i z —= CO3 W A $"( N K EXCAVATION SIZE (length xwidthxdepth): X$q-X S DEPTH SOIL TYPE OBSERVATION* SAMPLE # AP M I P P L E I N TRENCHSIZE(lengthxwidthxdepth): X X p -tttryt G H DEPTH TO GROUNDWATER: ft # HOURS SINCE DEWATERING: 2 p 11 SAMPLINGMETHOD: OBSERVATION*: ` p STOCKPILE SO Cubic Yards COVERED: ❑YES ONO SAMPLE#5f�SAMPLE# Sp S` S STOCKPILE ubic Yards COVERED: ❑ YES ❑ NO SAMPLE # SAMPLE # -%5 ke— OTHER SAMP S: D S S -c/` K © .3 I S — 2) LABORATORY: Argon SAMPLER'S NAME: Groundzero SgfkA CLOSURE IN PLACE: BACKFILL MIXTURE: I VOLUME: SITE MAP ATTACHED**. YES ❑ NO EH 23-0043 (Rev 512212007) IMPORTANT NOTES: Complete one form for each tank removed * Include all commentslobservations ** Site Map Required V