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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> UST/PIPING CLOSURE INSPECTION FORM <br /> SITE NAME : ARCO 07049 SR# : 0080535 <br /> ADDRESS : 800 E Kettleman Ln CITY : Lodi <br /> OWNER NAME : BP West Coast Products , LLC PHONE : 415-902-5089 <br /> CONTRACTOR : Town & Country Contractors , Inc PHONE : 916-636-9500 <br /> FIRE PERMIT # : 20171839 TANK # 39 10339507-002 <br /> ❑ PIPING REMOVAL ® UST REMOVAL ❑ CLOSURE IN PLACE ❑ TEMPORARY CLOSURE <br /> INSPECTOR : Elena Manzo & Shewit Woldearegay DATE : 7/16/2019 <br /> R RINSED : 99 YES ❑ NO METHOD : Triple Rinsed AMOUNT : 1 , 100-gallon <br /> N RINSATE DISPOSAL SITE : Nieto and Sons Trcuking , Inc. <br /> S <br /> E MANIFEST # : 012938459FLE OTHER TRACKING #: <br /> V AMOUNT USED : 1 ,400 Ib of dry ice <br /> A PURGED : ® YES ❑ NO METHOD : Dry ice <br /> P was used for all 4 tanks <br /> R READINGS AT REMOVAL . L . E. L. : 0 %D 02 : 0 %D COMMENTS* : <br /> C TANK MATERIAL : ❑ STEEL IN FIBERGLASS ❑ OTHER TANK SIZE: 10, 000-gallon <br /> 0 TANK CONDITION : ® GOOD ❑ POOR ❑ HOLES Comments* : <br /> N <br /> S PIPE MATERIAL : ❑ STEEL ® FIBERGLASS ❑ OTHER TTOTAL LENGTH OF PIPING <br /> T PIPE CONDITION , I@ GOOD ❑ POOR ❑ HOLES Comments*: <br /> DEPTH SOIL TYPE OBSERVATION * SAMPLE # <br /> T Silty/sandy soil Ground water and slab were not observed <br /> A <br /> N <br /> K <br /> EXCAVATION SIZE : X X <br /> Length Width Depth <br /> S DEPTH SOIL TYPE OBSERVATION * SAMPLE # <br /> A Silty/sandy soil Ground water and slab were not observed <br /> M I Soil color of greyish/green was observed near the dispenser/product <br /> P p <br /> lines with a gasoline odor <br /> L E <br /> N TRENCH SIZE : X X <br /> Length Width Depth <br /> C' H DEPTH TO GROUNDWATER: FT # HOURS SINCE DEWATERING : <br /> 2 <br /> 0 SAMPLING METHOD : OBSERVATION * : <br /> STOCKPILE#1 : Cubic Yards COVERED : ❑ YES ❑ NO SAMPLE # : Stockpile 1A SAMPLE # : Stockpile 113 <br /> STOCKPILE#2 : Cubic Yards COVERED : ❑ YES ❑ NO SAMPLE # SAMPLE # <br /> OTHER SAMPLES : <br /> LABORATORY: Eurofins Test America SAMPLERS NAME : Antea Group Ian Treat <br /> CLOSURE IN PLACE : BACKFILL MIXTURE : native material onsite UME : <br /> VOL <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 commentslobservations ** Site Map Required <br />