Laserfiche WebLink
IQYI 'L (SouF�'1 ) <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> UST/PIPING CLOSURE INSPECTION FORM <br /> SITE NAME: ]E j CprnpLn" (,(tet✓ SR#: 00(og C3(0 0 <br /> ADDRESS: -243j p , K40-6 0,3a IQ . CITY: �O L pi ) <br /> OWNER NAME: -To_n -F�fl no 0 PHONE: 1zoa� q41- 8�1 <br /> CONTRACTOR: 1_�B env�t.-orim dyA PHONE: (zm-)co2_ a(op(,e <br /> FIRE PERMIT#: NIoV-) eZ,,L n a F D an o+e, TANK#39 C)1 &1004 <br /> ❑ PIPING REMOVAL �.UST REMOVAL ❑ CLOSURE IN PLACE ❑ TEMPORARY CLOSURE <br /> INSPECTOR: (2i \, QX�� DATE: j 314 /Cf <br /> R RINSED:V YES ❑ NO METHOD: rj j /e Y/17S C'. AMOUNT: CQ LjO qQ - <br /> I <br /> N RINSATE DISPOSAL SITE: b�' �I x0 1 )j )�jQ 0 -V►'DY� (.1 aj-d .,7t>l k O n CFS <br /> S <br /> E MANIFEST If: OTHER TRACKING#: <br /> A PURGED: '.YES ❑ NO METHOD: -X:>y-L e. AMOUNT USED: <br /> P J 180 f <br /> R READINGS AT REMOVAL: L.E.L.:O- 0702: Zp 9�o COMMENTS*: W � <br /> jty � b �� <br /> C TANK MATERIAL: ZSTEEL ❑ FIBERGLASS ❑ OTHER TANK SIZE I0'1_ 0 0O� <br /> 0 TANKCONDITION: iA GOOD ❑ POOR ❑ HOLES Comments*: Da-1e.y C00.fin S Chipped O-K Ih cpo3S <br /> N <br /> S PIPE MATERIAL: ❑ STEEL If FIBERGLASS ❑ OTHER TOTAL LENGTH OF PIPING UIQ%tnc urn? oveA--tan Pit <br /> T PIPE CONDITION:py GOOD ❑ POOR ❑ HOLES Comments*: P;pi n- LUas Y i (sped Lt dunrlj exekziiorl <br /> DEPTH SOIL TYPE OBSERVATION* SAMPLE# <br /> T (5 a * r of Wr k;14C : Pl Yr #-2 ' & <br /> A 1c2- <br /> N j 2- E L&-lL <br /> K <br /> EXCAVATION SIZE: 38 f- X 2 t X t- <br /> vnap D� <br /> S DEPTH SOIL TYPE OBSERVATION* SAMPLE# <br /> A <br /> M <br /> P <br /> L E <br /> TRENCH SIZE: X X <br /> N IM� <br /> G -,,H/11DEPTH TO GROUNDWATER: FT If HOURS SINCE DEWATERING: <br /> 0 SAMPLING METHOD: OBSERVATION*: <br /> STOCKPILE#1: 20 Cubic Yards COVERED: O YES ANO SAMPLE#cSPI I SAMPLE# CSS/ —Z <br /> STOCKPILE#2: /60 Cubic Yards COVERED: ❑YES XNO SAMPLE#Sl�Z/,SPZ-2 SAMPLE# SP 2-3* SP1-y� PZ� <br /> OTHER SAMPLES: Z—� <br /> LABORATORY: 7—.e0.h_ SAMPLERSNAME: <br /> CLOSURE IN PLACE: BACKFILL MIXTURE: VOLUME: <br /> SITE MAP ATTACHED**: YES ❑ NO <br /> EH 23-0043(Rev 5I22I2007) T IMPORTANT NOTES: Complete one form for each tank removed <br /> I t�I -#2 (goLc+ t) *Include all commentslobservations **Site Map Required <br />