Laserfiche WebLink
SAN JOAQUIN C4'UNTY ENVIRONMENTAL HEAPH DEPARTMENT <br /> UST/PIPING CLOSURE INSPECTION FORM <br /> SITE NAME: C4 -j d �f bG V,6, QgAb SR#: DD S (,o Z-7 S' <br /> ADDRESS: Nto� l�}� 0� �� ( W. (NQG�t! /ave CITY: S46f4 0,1 <br /> OWNER NAME: C -r� S�v� IC, -� PHONE: 37 �JS�17 <br /> CONTRACTOR: Z!d,\.5 a A4rn 14&tlY� Con S I rvt+jjl\ PHONE: <br /> FIRE PERMIT#: Qq, 6r- fL TANK#39 <br /> ❑ PIPING REMOVAL UST REMOVAL ❑ CLOSURE IN PLACE ❑ TEMPORARY CLOSURE <br /> INSPECTOR: RAkmwj U60A gaA., DATE: <br /> R RINSED: YES ❑ NO METHOD: Tr ( L e,, �^ AMOUNT; j <br /> N RINSATE DISPOSAL SITE: benww <br /> S <br /> E MANIFEST M Z OTHER TRACKING M <br /> A PURGED: YES ❑ NO METHOD: �� AMOUNT USED: <br /> P <br /> D <br /> R READINGS AT REMOVAL: L.E.L.: Z9 02: O COMMENTS*: <br /> C TANK MATERIAL:9 STEEL L3 FIBERGLASS L3 OTHER TANK SIZE l bbG <br /> 0 TANK CONDITION: ❑ GOOD V POOR HOLES Comments*: On <br /> N <br /> S PIPE MATERIAL: ❑ STEEL ❑ FIBERGLASS ❑ OTHER TOTAL LENGTH OF PIPING - [1 <br /> T PIPE CONDITION:)f GOOD ❑ POOR ❑ HOLES Comments*: C d lam, <br /> DEPTH SOIL TYPE OBSERVATION* SAMPLE# <br /> T <br /> A 0 ^ F <br /> N <br /> K <br /> EXCAVATIONSIZE{ XVt�_X <br /> S DEPTH SOIL TYPE OBSERVATION* SAMPLE# <br /> A P C C 6S>rd -1 f _ <br /> M I �` ►'lam <br /> P P <br /> L E <br /> TRENCHSIZE: ��XX <br /> N <br /> G HDEPTH TO GROUNDWATER: FT #HOURS SINCE DEWATERING: <br /> 2 <br /> 0 SAMPLING METHOD: OBSERVATION*: <br /> STOCKPILE#1: Cubic Yards COVERED: OYES ❑ NO SAMPLE# SAMPLE# <br /> STOCKPILE#2: Cubic Yards COVERED: El YES ❑ NO SAMPLE SAMPLE# <br /> OTHER SAMPLES: <br /> LABORATORY: K SAMPLERS NAME: C Pr n I <br /> CLOSURE IN PLACE: BACKFILL MIXTURE: VOLUME: <br /> SITE MAP ATTACHED**:`YES ❑ NO <br /> EH 23-0043(Rev 5/2212007) IMPORTANT NOTES: Complete one form for each tank removed <br /> *Include all commentsiobservations **Site Map Required <br />