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SALE! JOAQUIN CC--JMTY ENVIRONMENTAL HEA" DEPARTMENT <br /> USTi/PIPIMC CLOSURE INSPECTION FORM <br /> SITE NAME: LV rL kL o t!ju���J'L. e -(41- Prooer'�`j SR#: obs' -78 5G7 <br /> ADDRESS: �'(S�-( f Y poCITY: T�0j <br /> OWNER NAME: PHONE: L16S— <br /> CONTRACTOR: PHONE: <br /> FIRE PERMIT#: 0!( 00 TANK#39 Q ,S- j 6G 7 cJ <br /> ❑ PIPING REMOVAL UST REMOVAL ❑ CLOSURE IN PLACE ❑ TEMPORARY CLOSURE <br /> INSPECTOR: yopi Luc DATE: 191 (":"1b� <br /> R RINSED: XYES ❑ NO METHOD: -r{-j pLe—, 2 i 1 fC-,, AMOUNT: �'Z'� <br /> N RINSATE DISPOSAL SITE: e/-7Z,04-j V I�tt G• f;� n�L, ( l.� &14 <br /> EMANIFEST OTHER TRACKING M <br /> V <br /> A PURGED: Z3�YES ❑ NO METHOD: rAMOUNT USED: 306 lb( <br /> P <br /> R READINGS AT REMOVAL: L.E.L.: 02: 1 COMMENTS*: I 0 CAI i�t174� z�,1 —7 2L <br /> C TANK MATERIAL: STEEL ❑ FIBERGLASS ❑ OTHER TANK SIZE �s U <br /> 0 TANK CONDITION: 7" GOOD ❑ POOR ❑ HOLES Comments*: (_4q�p/j <br /> N <br /> S PIPE MATERIAL:)4 STEEL ❑ FIBERGLASS ❑ OTHER TOTAL LENGTH OF PIPING <br /> T PIPE CONDITION: ❑ GOOD * POOR ❑ HOLES Comments*: <br /> DEPTH SOIL TYPE OBSERVATION* SAMPLE# <br /> T 3 C (- tsj UDOru GU I(>.r 12/0 x-\ 15OL20 N <br /> A <br /> N <br /> K <br /> EXCAVATION SIZE: ZD X _X P/ <br /> Length N4dth Depth <br /> S DEPTH SOIL TYPE OBSERVATION* SAMPLE# <br /> A P 619 6blb-i S44-f-) PiPf/) ) <br /> M I '3L cls r 2 <br /> P <br /> E k k a D <br /> TRENCH SIZE: 3 3 X� _X 2 <br /> NLength NAdth Depth <br /> G H DEPTH TO GROUNDWATER: FT #HOURS SINCE DEWATERING: <br /> 2 <br /> 0 SAMPLING METHOD: OBSERVATION*: <br /> STOCKPILE#1: �Cubic Yards COVERED: L)YES \yf NO SAMPLE# S P SAMPLET-- <br /> STOCKPILE#2: �_Cubic Yards COVERED: ❑YES %g NO SAMPLE# S� SAMPLE# LV` L. <br /> i <br /> OTHER SAMPLES: <br /> LABORATORY: ^ L/r SAMPLERS NAME: f U <br /> CLOSURE IN PLACE: BACKFILL MIXTURE: VOLUME: <br /> SITE MAP ATTACHED**: ES ❑ NO <br /> EH 23-0043(Rev 5/22/2007) IMPORTANT NOTES:Complete one form for each tank removed <br /> *Include all commentslobservations **Site Map Required <br />