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SJLHD - UNDE"3ROUND TANK CLOSURE/AI(ANDON"ENT INSPECTION <br /> (SHADED ARI` TO DE FILLED IN FOR THE FAST TANK ONLY) <br /> G OWNER NAME e OWNER PHONE N yg ,)sem <br /> E <br /> N CONTRACTORc_ I I Cir CON. PHONEM 2�� y� �(� Z <br /> E � <br /> R SJLHD PERMIT Y EPA Nrq c C»O r6' t3FIRE PERMIT 01 <br /> L ( M ONE <br /> INSPECTOR C I�UN DATE 3 TANK q 39 - /0/0 <br /> R RINSED �N) METHOD ,�c h9 _ rpt RINSE AMOUNT.. 1/0 a <br /> I <br /> N RINSATE DISPOSAL SITE jo Er+�So J <br /> S <br /> E MANIFEST Y -OR- OTHER <br /> V VAPORS PURGED (Y N) METHOD AMOUNT USED <br /> A S <br /> l� (E <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) dc'Nc <br /> 0 <br /> T R COMMENTS <br /> A — <br /> N TANK MATERIA (STEEL FIBERGLASS, OTHER) TANK SIZE !)0 U <br /> K C L <br /> / 0 TANK CONDITION GOOD POOR, HOLES) <br /> P N <br /> I S PIPE MATERIAL (STEE , FIBERGLASS, OTHER) Y FEET 2 S <br /> P T <br /> I PIPING CONDITION (GOOD POOR, HOLES ) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE I <br /> T <br /> F A yc(av or Na 0 o sry v 1 <br /> I N ` ' C4 /0001 ^ riesco(m4lav 1 S <br /> E K <br /> L <br /> D EXCAVATION SIZE: L x X ZFS YDS OF SOIL : 20 oIS' <br /> 3- <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE I <br /> N M P , <br /> S P I Q J ac, <br /> P L P <br /> 2` aaw I o N <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION NA X X YDS OF SOIL <br /> I <br /> 0 H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 1 OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: <br /> L] [ LABORATORY: C4nO,j,p �,,6c SAMPLERS NAME: Joe( <br /> CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> PH '_'3 013(7/88) <br />