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Time In: <br /> Time Out: <br /> opQ.�tN. San Joaquin County <br /> .X Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �... P Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> �<<FORtN <br /> Underground Storage Tank Program Service Request Inspection Report <br /> Name of Facility: FLYING J TRAVEL PLAZA#618* Date: 01/02/2020 <br /> Address: 1501 N JACK TONE RD , RIPON 95366 <br /> Requestor: JONES COVEY GROUP, INC Telephone: <br /> Program Element: 2304-UST REMOVAL Request#: SR0081075 <br /> Inspection Type: 134-UST REMOVAL INSPECTION <br /> Onsite Service Technician: Ovidiu Valimareanu ICC Service Tech/Installer Exp. Date: 01/28/2021 <br /> Manufacturer training: <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> NOTES <br /> On site for the following inspections: <br /> -Verified a copy of the Health and Safety Plan (HASP)was on the jobsite for review. <br /> -Verified that the tank was inerted with dry ice after the triple rinsing process took place at the 30-pounds of dry ice per <br /> 1,000-gallon volume rate.According to the Praxair receipt observed onsite, 50 pounds of dry ice was used to complete this <br /> process. <br /> -Verified the hazardous waste manifest for the rinsate that was generated. <br /> -Witnessed lower explosion level (LEL)reading of the bottom, middle, and top section of inside the tank. The LEL reading was <br /> 0%. Reading was taken by Jeff Hanson, Certified Marina Chemist. <br /> -Witnessed spray painting of the tank ID(039-10182131-007)on the side of the tank. <br /> -Soil sampling is scheduled for tomorrow, 1/3/2020. <br /> -Verified EHD's Underground Storage Tank Disposition Tracking Record Sheet was accompanying the tank as it was being <br /> hauled away. <br /> -Hazardous Waste Tank Closure Certification was obtained while EHD was onsite. <br /> NOTE: In addition,the following information must be submitted within 30 days after the UST removal. <br /> 1)Analytical results: only results that come directly from a third-party California certified laboratory with affixed chain of custody <br /> will be accepted by EHD. <br /> 2) UST tracking Record Sheet and/or Tank and Piping Hazardous Waste Manifest Tank Closure Certification Form (DTSC <br /> Form 1249) <br /> 3) Hazardous Waste Manifest for rinsate and residual product, disposal records for piping, spill containers and sumps. <br /> 4) Backfill Excavation Certification <br /> The person in charge is responsible for ensuring that the above mentioned facility is in compliance with all applicable sections of the California Health and <br /> Safety Code.If a reinspection is required,fees will be assessed at the current hourly rate. <br /> OBJ <br /> Received by: Name and Title: Ovidiu Valimarenu, Service Tech <br /> EH Specialist: SHEWIT WOLDEAREGAY Phone: (209)468-0216 <br /> FA0006672 SR0081075 SC134 01/02/2020 <br /> EHD 23-01 Rev.06/30/15 Page 1 of 1 Underground Storage Tank Program Service Request Inspection Report <br />