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SAN JOAQUIN O NTY ENVIRONMENTAL MEAL H DEPARTMENT <br /> STtr-IPING CLOSURE INSPECTION FOR <br /> SITE NAME: <br /> SR : 61 4 <br /> ADDRESS: 161z, CITY: <br /> OWNER NAME: PHONE:( - ) <br /> CONTRACTOR: PHONE: '5�vr,� I <br /> FIRE PERMIT : TANK#39 <br /> (PING REMOVAL ❑ UST REMOVAL ❑ CLOSURE IN PLACE ❑ TEMPORARY CLOSURE <br /> INSPECTOR: DATE: <br /> R RINSED: ❑YES NO METHOD: LA _7AMOUNT: 0,4 <br /> I <br /> N RINSATE DISPOSAL SITE: AJIA <br /> EMANIFEST M OTHER TRACKING M A-)114 <br /> V <br /> A PURGED: ❑YES NO METHOD: AMOUNT USED: <br /> P <br /> 0 READINGS AT REMOVAL: L.E.L.: 02: COMMENTS*: <br /> C TANK MATERIAL: ❑ STEEL ❑ FIBERGLASS ❑ OTHER TANK SIZE <br /> 0 TANK CONDITION: ❑ GOOD ❑ POOR ❑ HOLES Comments*: AO <br /> N <br /> S PIPE MATERIAL: ❑ STEEL XFIBERGLASS ❑ OTHER TOTAL LENGTH OF PIPING X 5,:, <br /> T PIPE CONDITION: GOOD ❑ POOR ❑ HOLES Comments*: i f 1141)Gs 1,4 s <br /> DEPTH SOIL TYPE OBSERVATION* Wqn! 33'7A PLE# <br /> T <br /> A <br /> N <br /> K <br /> EXCAVATION SIZE: X X <br /> Leflo Ma D" <br /> S DEPTH SOIL TYPE OBSERVATION* SAMPLE# <br /> M 1 <br /> L E �i �� �,� pr,�a .Q �. sem,`/ ,- <br /> N TR NCH SIZE: X X <br /> th <br /> G H DEPTH TO GROUNDWATER: FT #HOURS SINCE DEWATERING: <br /> 2 <br /> 0 SAMPLING METHOD: N A OBSERVATION*: r y, <br /> STOCKPILE#1: Cubic Yards COVERED: ❑YES 0 SAMPLE# =4p d e. SAMPLE# <br /> STOCKPILE#2: Cubic Yards COVERED: ❑YES ❑ NO AMPLE# SAMPLE# <br /> OTHER SAMPLES: <br /> LABORATORY: rig l,"mss L�j SAMPLERS NAME: - �• . <br /> CLOSURE IN PLACE: BACKFILL MIXTURE: VOLUME: <br /> SITE MAP ATTACHED**: YES ❑ NO <br /> EH 23-0043(Rev 5/22/27) IMPORTANT NOTES:Complete one form for each tank removed <br /> *Include all commentstobservations **Site Map Required <br />