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0 9 <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />UST/PIPING CLOSURE <br />INSPECTION <br />FORM <br />N <br />SITE NAME: SJ REGIONAL TRANSIT <br />SR#: <br />0068638 <br />ADDRESS: 1533 E. LINDSAY <br />OTHER TRACKING M <br />CITY: <br />STOCKTON <br />OWNER NAME: SJ REGIONAL TRANSIT <br />METHOD: r S C <br />PHONE: <br />467-6671 <br />CONTRACTOR: TERRACO (SR REQUESTOR) <br />/ JIM THORPE (REMOVAL) <br />PHONE: <br />847-906-5019 <br />FIRE PERMIT #: COS FIRE DEPART 1-13-14 <br />0 <br />TANK # 39 <br />580115817 <br />® PIPING REMOVAL ® UST REMOVAL <br />❑ CLOSURE IN PLACE <br />❑ TEMPORARY CLOSURE <br />INSPECTOR: JEFFREY WONG <br />DATE: 3/4/2014 <br />R RINSED:YES ❑ NO METHOD: <br />I <br />r: $Q <br />AMOUNT: <br />a'� -�� <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 />N <br />RINSATE DISPOSAL SITE: <br />E <br />MANIFEST #: <br />Z 363 DO <br />OTHER TRACKING M <br />A <br />P <br />PURGED$1YES ❑ NO <br />METHOD: r S C <br />AMOUNT USED: J0o <br />R <br />READINGS AT REMOVAL: <br />L.E.L.: 02: COMMENTS*: <br />C <br />TANK MATERIAL: [ISTEEL ® FIBERGLASS ElOTHER <br />TANK SIZE: 20,000 (Diesel) <br />0 <br />TANK CONDITION: ❑ GOOD ❑ POOR ❑ HOLES COMMENTS*: <br />NJ <br />S <br />PIPE MATERIAL: [-]STEEL Vj FIBERGLASS ❑ OTHER <br />TOTAL LENGTH OF PIPING: C+ r I r d <br />T <br />PIPE CONDITION: F1 GOOD [-]POOR ❑ HOLES COMMENTS*: &a$k4. <br />DEPTH <br />SOIL TYPE <br />OBSERVATION* <br />SAMPLE # <br />T <br />S* <br />o P r dVJ <br />A <br />d <br />Nv mdor d; scob mnf" <br />'3— <br />N <br />K <br />EXCAVATION SIZE (length x width x depth): X �1 X <br />S <br />DEPTH <br />SOIL TYPE <br />OBSERVATION* <br />SAMPLE # <br />A <br />P <br />M <br />I <br />P <br />P <br />L <br />E <br />I <br />N <br />TRENCH SIZE (length x width x depth): X X jJ C C t d(t Q v ro K d- QkmD C <br />G <br />H <br />DEPTH TO GROUNDWATER: ft <br /># HOURS SINCE DEWATERING: <br />2 <br />O <br />SAMPLING METHOD: <br />OBSERVATION*: <br />STOCKPILE# 5Q Cubic Yards COVERED: ❑ YES ❑ NO SAMPLE# 5f('�SAMPLE# SP%s 5;J919, Zt7 <br />STOCKPILE4&1/)Wubic Yards COVERED: ❑ YES ❑ NO SAMPLE # SAMPLE # Ni l4tJ <br />OTHER SAMPLES: <br />LABORATORY: Argon <br />SAMPLER'S NAME: Groundzero; % � <br />CLOSURE IN PLACE: I <br />BACKFILL MIXTURE: <br />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 />