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SJLHD - UNDERGPOUND TANK CLOSURE/ABANDONME"T INSPECTION <br /> (SHADED AREA BE FILLED IN FOR THE FIR: TANK ONLY) <br /> G [7ccr` p� u - C <br /> OWNERE P//� OWNER PHONE #�ao9)�3 -`fl 7Erd NCONTRACTOR -T7L6-r CON. PHONE# <br /> RSJLHD PERMIT # EPA # FIRE PERMIT <br /> A <br /> L <br /> _ <br /> tINSPECTOR 1S` pp DATANK # 39 <br /> R RINSED (Y METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGEDY N) METHOD < v AMOUNT USED a 6 1Z <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST < 208) NA <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL TEEL FIBERGLASS, OTHER) TANK SIZE a / �1 <br /> K C 4 rcl 7 Cl�r/�S <br /> / 0 TANK CONDITION (GOOD, POORJ , HOLES ) <br /> P N <br /> I S PIPE MATERIAL STEEL FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, ( 00 HOLES ) a/ <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A <br /> I N uT ? W <br /> E K <br /> D EXCAVATIO SIZ X X YDS OF SOIL: <br /> S ' <br /> I A ['�TR;N <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M <br /> S P <br /> P L <br /> E I <br /> C N <br /> T GENCH DIMENSION X r_� X YDS OF SOIL (pfD 7 5 <br /> I �� �,� i•S>.Ile uJ+Gtvri <br /> 0 DE .W. : — FT SAMPLING METHOD N # SINCE DEWATERING: <br /> OTHER SAMPLE: i--uatt4J <br /> LABORATORY: (� fGG � qi SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />