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SJLHD - UNDERCOUND TANK CLOSURE/ABANDONMFNT INSPECTION <br />(SHADED AREA O BE FILLED IN FOR THE FIE TANK ONLY) <br />+ <br />DRAW SITE MAP ON REVERSE <br />Q r" <br />G < <br />OWNER NAME ell <br />OWNER PHONE # _ <br />E <br />N <br />E <br />R � <br />A <br />L <br />CONTRACTORCON. PHONE# <br />p i� <br />FIRE PERMIT # el-, .... .I � <br />SJLHD PERMIT # EPA # ,,,,, ; <br />_ <br />INSPECTORK• Ft --,,EY <br />DATE /25/t38 <br />TANK # 39 <br />R <br />RINSED (Yco <br />METHOD <br />RINSE AMOUNT <br />I <br />N <br />RINSATE DISPOSAL SITE <br />S <br />E <br />MANIFEST # -OR- OTHER <br />VAPORS PURGED (Y/N) METHODI>W TCE AMOUNT USED A <br />V <br />A <br />P <br />L.E.L. READING AT REMOVAL (MUST BE < 20%) <br />T <br />A <br />N <br />O <br />R <br />, <br />COMMENTS <br />TANK MATERIAL(�STEE FIBERGLASS, OTHER) TANK SIZE 100,0 ^ <br />K <br />/ <br />C <br />O <br />TANK CONDITION (GOOD, OOR, HOLES)-,, <br />o� Cor25i�n� <br />P <br />I <br />N <br />S <br />PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) <br /># FEET <br />P <br />I <br />T <br />PIPING CONDITION (GOOD, POOR, HOLES) <br />N <br />G <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />T <br />F <br />A <br />r <br />I <br />N <br />E <br />K <br />w u 2 <br />D <br />EXCAVATION SIZE:�X <br />YDS OF SOIL: �y <br />I <br />S- <br />ADEPTH <br />SOIL TYPE OBSERVATION SAMPLE # <br />N <br />M <br />P <br />S <br />P <br />I <br />P <br />L <br />P <br />E <br />I <br />E <br />C <br />T <br />N <br />G <br />TRENCH DIMENSION X X <br />YDS OF SOIL <br />I <br />0 <br />N <br />H <br />2 <br />0 <br />DEPTH TO G.W.: ny BrcoJ SAMPLING METHOD - <br /># OF HOURS SINCE DEWATERING: ' <br />OTHER SAMPLE: - <br />LABORATORY:Hln� SAMPLERS NAME: — <br />CLOSURE IN PLACE <br />MIXTURE: <br />VOLUME: _ <br />DRAW SITE MAP ON REVERSE <br />