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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> UST/PIPING CLOSURE INSPECTION FORM <br /> SITE NAME: hnp AIA e w -4-tipSR#: 006 1a45 <br /> ADDRESS: G� 4�` {���, yp� CITY: <br /> OWNER NAME: PHONE: <br /> CONTRACTOR: P�KL a , –L-dAg MG � ePHONEAG 6 -bin -qS 3 <br /> FIRE PERMIT#: TANK# 39a,��6 <br /> A PIPING REMOVAL ❑ UST REMOVAL ❑ CLOSURE IN PLACE ❑ TEMPORARY CLOSURE �����'�► <br /> INSPECTOR: A DATE: l a- 0C/- -)-0 � <br /> R RINSED: ❑YES ❑ NO METHOD: AMOUNT: <br /> I <br /> N RINSATE DISPOSAL SITE: <br /> S 7— <br /> E MANIFEST#: OTHER TRACKING#: <br /> V <br /> A PURGED: ❑YES ❑ NO METHOD: d,N cu, AMOUNT USED: 3(� <br /> P <br /> R READINGS AT REMOVAL: L.E.L.: ,�r 02: .� 0,61 COMMENTS*: <br /> C TANK MATERIAL: ❑ STEEL -0---FIBERGLASS ❑ OTHER TANK SIZE <br /> 0 TANK CONDITION:..O'GOOD L3 POOR LJ HOLES Comments*: N Ctar( - r, --Q' g 04 R b5 <br /> N <br /> S PIPE MATERIAL: ❑ STEEL FgrFIBERGLASS ❑ OTHER TOTAL LENGTH OF PIPING <br /> T PIPE CONDITION:..0 GOOD ❑ POOR ❑ HOLES Comments*: <br /> DEPTH SOIL TYPE OBSERVATION* SAMPLE# <br /> T 12 ",-141+11 "I l +�1 <br /> A 1'Z 6i I <br /> N /� G <br /> K <br /> EXCAVATION SIZE: X29X1z <br /> Length 'Mdth C.Pth <br /> S DEPTH SOIL TYPE OBSERVATION* SAMPLE# <br /> A P <br /> M <br /> P P <br /> L E <br /> TRENCH SIZE: —X—X <br /> NLength width Depth <br /> GDEPTH TO GROUNDWATER: FT #HOURS SINCE DEWATERING: <br /> E0 : <br /> SAMPLING METHOD: OBSERVATION*: <br /> STOCKPILE#1: Cubic Yards COVERED: ❑YES ❑ NO SAMPLE# SAMPLE# <br /> STOCKPILE#2: Cubic Yards COVERED: ❑YES ❑ NO SAMPLE# SAMPLE# _. <br /> OTHER SAMPLES: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE: BACKFILL MIXTURE: VOLUME: <br /> SITE MAP ATTACHED**: ❑YES ❑ NO <br /> EH 23-0043(Rev 5/22/2007) IMPORTANT NOTES: Complete one form for each tank removed <br /> *Include all commentsiobservations **Site Map Required <br />