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SJLHD - UNDERGROUND 'TANK CLOSURE/Al(ANDUN,,'JAi'P INSPEC IUN <br />(SHADED ARE TO DE FILLED IN FOR THE F ST TANK ONLY) <br />-.`J--L--------------------------- <br />SA N <br />_. - <br />FFG <br />'NAMEr0+rfcc4 <br />SAN <br />E <br />OWNER <br />SuNbC4lrbm lliN: <br />OWNER q 209-`/%6-5086 <br />N <br />E <br />f CONTRACTOR •� S <br />CON. PHONE# �o? -731 -6810 <br />JLHD PERMITtl� EA NGq; FIRE PERMIT q <br />INSPECTOR Gam{ <br />DATE S <br />TANK 0 39 <br />R <br />I <br />RINSED (Y )METHOD Ude W RINSE AMOUNT [/Q <br />(�cc <br />N <br />S' <br />RINSATE DISPOSAL SITEN <br />CRs <br />E <br />MANIFEST # -OR- OTHER <br />V <br />A <br />VAPORS PURGED /N) <br />METHOD <br />cp <br />AMOUNT USED a bs <br />L.E.L. READING AT REMOVAL (MUST BE < 203) N � N e <br />P <br />0 <br />COMMENTS- <br />T <br />R <br />-A <br />N <br />K <br />C <br />TANK MATERIAL((STEE FIBERGLASS, OTHER) <br />TANK SIZE llo() <br />/ <br />0 <br />TANK CONDITION (GOOD, POOR HOLES) <br />P <br />N <br />I <br />P <br />S <br />T <br />PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) <br /># FEET/°' °✓<c <br />I <br />PIPING CONDITION (GOODOO�R HOLES) <br />N <br />G <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />T <br />F <br />A <br />^ S ✓ n7 5 <br />I <br />N <br />E <br />K <br />L <br />D <br />s- <br />EXCAVATION SIZE: X L X i-- <br />YDS OF SOIL: <br />I <br />A <br />DEPTH 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 />E <br />I <br />C <br />N <br />T <br />G <br />TRENCH DIMENSION X X <br />YDS OF SOIL <br />I <br />O <br />H <br />DEPTH TO G.W.: FT <br />SAMPLING METHOD <br />N <br />2 <br />0 <br /># OF HOURS SINCE DEWATERING: <br />SAMPLE: <br />HF-olOTHER <br />LABORATORY: F -G4 <br />SAMPLERS NAME: Jam! N Qu NN <br />CLOSURE IN PLACE <br />I MIXTURE: <br />VOLUME: <br />DRAW SITE MAP ON REVERSE <br />Fil 23 043(7/88) <br />