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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />UST/PIPING CLOSURE INSPECTION FORM <br />EH 23-0043 (Rev 5/22/2007) IMPORTANT NOTES: Complete one form for each tank removed <br /> * Include all comments/observations ** Site Map Required <br />SITE NAME: Lawrence Livermore National lab site 300 SR#: 2501291 <br />ADDRESS: 15999 W Corral Hollow Rd, Tracy, CA 95376 CITY: Tracy <br />OWNER NAME: Lawrence Livermore National Lab PHONE: (925) 341-9093 <br />CONTRACTOR: Wayne Perry Inc. PHONE: (714) 381-2519 <br />FIRE PERMIT #: N/A TANK # 10154767-003 <br /> PIPING REMOVAL x UST REMOVAL  CLOSURE IN PLACE  TEMPORARY CLOSURE <br />INSPECTOR: Monica De Anda DATE: 10/9/2025 <br /> <br />R <br />I <br />N <br />S <br />E <br />RINSED: x YES  NO METHOD: triple rinse AMOUNT: 2- 55 gal drums <br />RINSATE DISPOSAL SITE: Clean Harbors Environmental Services <br />MANIFEST #: N/A OTHER TRACKING #: N/A <br />V <br />A <br />P <br />O <br />R <br />PURGED: x YES  <br />NO METHOD: dry ice AMOUNT USED: unknown <br />READINGS AT REMOVAL: L.E.L.: 0% O2: 20.8% COMMENTS*: <br />C <br />O <br />N <br />S <br />T <br />TANK MATERIAL: x  STEEL x FIBERGLASS  OTHER TANK SIZE____1,500 gal________________ <br />TANK CONDITION: x GOOD  POOR  HOLES Comments*: <br />PIPE MATERIAL:  STEEL x  FIBERGLASS  OTHER TOTAL LENGTH OF PIPING __________________________ <br />PIPE CONDITION:  GOOD  POOR  HOLES Comments*: Removed <br />S <br />A <br />M <br />P <br />L <br />I <br />N <br />G <br />T <br />A <br />N <br />K <br />DEPTH SOIL TYPE OBSERVATION* SAMPLE # <br />10’ Alluvium Slightly damp – no odor D1-E <br />10’ Sand w/ Clays Slightly damp – no odor D1-W <br /> <br /> <br /> EXCAVATION SIZE: _16’_______ X _8’_______ X __10”______ Length Width Depth <br />P <br />I <br />P <br />E <br />DEPTH SOIL TYPE OBSERVATION* SAMPLE # <br />2’ Alluvium Dry- no odor L-1 <br /> <br /> <br /> <br />TRENCH SIZE: __10”______ X _10”_______ X __10”______ Length Width Depth <br />H <br />2 <br />O <br />DEPTH TO GROUNDWATER: ___________ FT # HOURS SINCE DEWATERING: <br />SAMPLING METHOD: OBSERVATION*: <br />STOCKPILE#1: _____8______ Cubic Yards COVERED:  YES  NO SAMPLE #_D1SP-1A___________________ SAMPLE # _____________ <br />STOCKPILE#2: ___________ Cubic Yards COVERED:  YES  NO SAMPLE #____________________ SAMPLE # ____________________ <br />OTHER SAMPLES: <br />LABORATORY: SAMPLERS NAME: Michael Hendry <br />CLOSURE IN PLACE: BACKFILL MIXTURE: VOLUME: <br />SITE MAP ATTACHED**:  YES  NO <br />