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SJLHU - UNDEPGROUND TANK CLOSURE/AB.ANDONMENT INSPECTION <br /> (SHADED ARI TO BE FILLED IN FOR THE F ;T TANK ONLY) <br /> . . . . . . . . . . . . . <br /> L • O' r U� S. Avt2 c�Yclt <br /> G < OWNER NAME OWNER PHONE E <br /> E <br /> N < CONTRACTOR_AL S CON. PHONE# <br /> E <br /> R SJLHD MIT # EPA # FIRE PERMIT # <br /> A <br /> L <br /> INSPECTOR rAJ)ltj DATE '�_(_�� TANK # 39 - <br /> HER RINSED (Y/N) METHOD RINSE AMOUNT <br /> I _. <br /> N RINSATE DISPOSAL SITE <br /> S - <br /> MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (f�7N) METHOD '� 7v-zVAMOUNT USED ��� <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIALTE , FIBERGLASS, OTHER ) TANK SIZE C <br /> K C - <br /> / 0 TANK CONDITION , POOR, HOLES ) <br /> P N <br /> I S PIPE MATERIAL EL,-'FIBERGLASS, OTHER) # FEET <br /> P T � ^ / <br /> I PIPING CONDITION (GOOD, �, i HOLES ) C��f PCZ <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T aS �k <br /> F A <br /> I N C O c +( QL <br /> E K <br /> L <br /> D EXCAVATION SIZE: —� ((v YDS OF SOIL : soy <br /> g <br /> S- <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I — <br /> 0mo <br /> DEPTH TO G.W. : FT SAMPLING METHOD <br /> N <br /> # OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: <br /> LABORATORY: QoO� IR ((CQy�Wat4 i4� SAMPLERS NAME: A�N �Tpr(1 <br /> E <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />