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� <br />SAN JOAQUIN CITY ENVIRONMENTAL HEALTH DEPARTMENT Z <br />UST/PIPING CLOSURE INSPECTION FORM <br />SITE NAME: SJ REGIONAL TRANSIT SR#: 0068638 <br />ADDRESS: 1533 E. LINDSAY CITY: STOCKTON <br />OWNER NAME: SJ REGIONAL TRANSIT PHONE: 467-6671 <br />CONTRACTOR: TERRACO (SR REQUESTOR) / JIM THORPE (REMOVAL) PHONE: 847-906-5019 <br />FIRE PERMIT #: COS FIRE DEPART 1-13-14 TANK # 39 580115813 <br />❑ PIPING REMOVAL ® UST REMOVAL ❑ CLOSURE IN PLACE ❑ TEMPORARY CLOSURE <br />INSPECTOR: JEFFREY WONG DATE: 3/4/2014 <br />R <br />I <br />RINSED: YES ❑ NO <br />METHOD:4119 E <br />AMOUNT: <br />N <br />RINSATE DISPOSAL SITE: <br />S <br />E <br />MANIFEST 9: <br />OTHERTRACKINGM <br />A <br />P <br />PURGED: YES ❑ NO <br />METHOD: <br />AMOUNT USED: <br />Jd <br />RREADINGS <br />AT REMOVAL: <br />L.E.L.: 02: COMMENTS*: <br />C <br />TANK MATERIAL: ❑ STEEL ® FIBERGLASS ❑ OTHER <br />TANK SIZE: 6000 (W.O., ) <br />0 <br />TANK CONDITION: ❑ GOOD ❑ POOR ❑ HOLES COMMENTS*: <br />N <br />S <br />PIPE MATERIAL: ❑ STEEL P FIBERGLASS ❑ OTHER <br />TOTAL LENGTH OF PIPING: <br />T <br />PIPE CONDITION: ❑ GOOD ❑ POOR ❑ HOLES COMMENTS*: <br />DEPTH <br />SOIL TYPE <br />OBSERVATION* <br />SAMPLE# <br />T <br />sl <br />No o r d is cJ to rc <br />e 1J <br />A <br />r C6 10 r -a-( <br />$' <br />N <br />K <br />EXCAVATIONSIZE(lengthxwidthxdepth 34)C 2 X Via^ <br />S <br />DEPTH <br />SOIL TYPE <br />BSERVATION* <br />SAM.PLE #p <br />A <br />p <br />dew <br />Al o G'' [ ie o C he �M <br />— J 1 0 ` �- <br />M <br />l <br />P <br />P <br />L <br />E <br />NTRENCH <br />SIZE (length x width x depth): QD X V X `4 (f (or F -r <br />G <br />H <br />DEPTH TO GROUNDWATER: ft <br /># HOURS SINCE DEWATERING: <br />2 <br />0 <br />SAMPLING METHOD: <br />OBSERVATION*: <br />STOCKPIL Cubic Yards COVERED: ❑ YES ❑ NO SAMPLE # SAMPLE# <br />STOCKPILE <br />Cubic Yards COVERED: [-]YES ❑ NO SAMPLE # SAMPLE # <br />OTHER SAMP ES: <br />LABORATORY: Argon <br />SAMPLER'S NAME: Groundzero , -15 <br />CLOSURE IN PLACE: <br />BACKFILL MIXTURE: <br />VOLUME: <br />SITE MAP ATTACHED**: YES ❑ NO <br />EH 23-0043 (Rev 5/2212007) IMPORTANT NOTES: Complete one form for each tank removed <br />* Include all commentsiobservations ** Site Map Required <br />0 <br />