Laserfiche WebLink
SAN JOAQUIN CANTY ENVIRONMENTAL HEAD I H DEPARTMENT <br /> E &, 1- UST/PIPING CLOSURE INSPECTION FORM TA1�L <br /> I✓a?1` <br /> SITE NAME: `O'� r1 j�L b'l4 �C" (G� SR#: DU S (z> 2. <br /> ADDRESS: `�"�(Z�' � (AI�ZI3 Ql`_ 41AA . CITY: <br /> OWNER NAME: �� rf��fi l�nA/� AU/hS�rn PMa PHONE: G/3 7— -7S"� <br /> PHONE: mo <br /> CONTRACTOR: nA n� � TANK#39 p�)� <br /> FIRE PERMIT#: Q p- wI l — <br /> ❑ PIPING REMOVAL X UST REMOVAL ❑ CLOSURE IN PLACE ❑ TEMPORARY CLOSURE <br /> INSPECTOR: DATE: lJ <br /> R RINSED: 1XYES ❑ NO 1 METHOD: AMOUNT: <br /> N RINSATE DISPOSAL SITE: fL/VI?lY►'U K(rj-/�Oi7� <br /> EMANIFEST CLOS 5v. OTHER TRACKING#: <br /> A PURGED: YES ❑ NO METHOD: Ur ��� AMOUNT USED: 20 # f <br /> P <br /> D READINGS AT REMOVAL: L.E.L.: 02: COMMENTS*: <br /> R <br /> C TANK MATERIAL:)(STEEL ❑ FIBERGLASS ❑ OTHER TANK SIZE UUU J <br /> 0 TANK CONDITION: ❑ GOOD ❑ POOR )KHOLES Comments*: h6tc.- oA 4fn 2hr< bokvN 4 Cei, � <br /> N <br /> S PIPE MATERIAL: ❑ STEEL ❑ FIBERGLASS ❑ OTHER TOTAL LENGTH OF PIPING <br /> T PIPE CONDITION: ❑ GOOD ❑ POOR ❑ HOLES Comments*: <br /> DEPTH SOILTYPE OBSERVATION* SAMPLE# <br /> T 0 <br /> A , <br /> N � r � <br /> t�C <br /> K <br /> EXCAVATION SIZE: i r�X X <br /> S DEPTH SOIL TYPE OBSERVATION* SAMPLE# <br /> A P <br /> M I <br /> P P <br /> L E <br /> tTRENCH SIZE: X X Pte_ <br /> N u <br /> G H TO GROUNDWATER: - FT #HOURS SINCE DEWATERING: <br /> 2 p0 ING METHOD: 9A 9'L L OBSERVATION*: I /j <br /> A <br /> STOCKPILE#1: �D Cubic Yards COVERED: L3 YES ilNO SAMPLE# CP SAMPLE# <br /> STOCKPILE#2: Cubic Yards COVERED: OYES ❑ NO SAMPLE# SAMPLE# <br /> ASITEMAPATTAC4HEED": YES <br /> ER SAL <br /> ORATOA (f�L SAMPLERS NAME: SLb� r h <br /> IN PLAL MIXTURE: VOLUME: <br /> ❑ NO <br /> EH 23-0043(Rev 512212007) IMPORTANT NOTES:Complete one form for each tank removed <br /> *Include all commentsiobservations **Site Map Required <br />