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SJLHD - UNDERGROUND STO- GE TANK CLOSURE/ABANDONME INSPECTION CHECKLIST <br />(SHADED AREA -,, BE FILLED IN FOR THE FIR,,�' TANK ONLY) <br />Flf- <br />%lllrllll��-r Fo i.ji ug - <br />I,' .1 'Vi <br />a 4 1419, <br />N <br />G <br />E <br />N <br />E <br />R <br />A <br />L <br />OWNER NAME 171 OWNER PHONE <br />. . ... ........ . . <br />NE <br />CONTRACTORCON. PHO # <br />SJLHD P MIT # EPA # E P T <br />r-1ke?lW:f1 <br />v: "i"a-V fit :.I f <br />SJLH D INSPECTOR TANK 0 39 <br />R RINSED (Y/N) METHO RINSE AMOUNT <br />I <br />N RINSATE DISPOSAL SITE <br />S. . . .... .............. . .. .............. ....... . ........ <br />E MANIFEST # -OR- OTHER <br />V <br />A <br />VAPORS PURGED (Y/N) <br />METHOD AMOUNT USED <br />I - <br />P <br />L.E.L. READING AT REMOVAL (MUST BE < 20%) <br />0 <br />T <br />R <br />------ <br />COMMENTS /0 <br />A <br />N <br />TANK MATERI OTHER) TANK SIZE <br />K <br />P <br />I <br />C <br />0 <br />N <br />S <br />TANK CONDITI <br />�YPOOR H 0 LE S) 4;Q j (40 <br />PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br />P <br />T <br />I <br />PIPING CONDITION (GOOD, POOR, HOLES) <br />N <br />"I <br />--- <br />- <br />G <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />T <br />F <br />IN <br />A <br />1.4 <br />-- - ------ <br />E <br />L <br />D <br />K <br />*I <br />- <br />------ <br />EXCAVATION SIZE: YDS OF SOIL: — <br />�Xl X? <br />I il <br />I <br />A <br />DEPTH SOILTYPE <br />OBSERVATION <br />SAMPLE # <br />N <br />S <br />M <br />P <br />PL <br />. .... .. ....... .. .... <br />.. ........ .. <br />E <br />I <br />C <br />N <br />"-YDS <br />T <br />G <br />TRENCH DIMENSIONS: OF SOIL: <br />I <br />0 <br />H <br />DEPTH TO G.W.: 1:2 1 FT METHOD <br />N <br />2 <br />0 <br /># OF HOURS SINCE DEWATERING: <br />OTHER SAMPLE: <br />Hr❑071 <br />LABORATORY:SAMPLERS <br />NAME: <br />CLOSURE IN PLACE-� <br />MIXTURE: <br />VOLUME: <br />DRAW SITE MAP ON REVERSE <br />