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SJLHD - UNDF -ROUND TANK CLOSURE/AI(ANDO' ','NT INSPECTION <br /> (SHADED ARE! w TO BE FILLED IN FOR THE FxmwST TANK ONLY) <br /> It I <br /> G OWNER NAME OWNER PHONE #(4 9 A/& o 7a{o <br /> E L <br /> N CONTRACTOR CON. PHONE# <br /> E <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> INSPECTORT DATE 3 g 9 TANK # 3.9 <br /> R RINSED METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S r, eSubriei <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED ON) METHOD AMOUNT USED O <br /> A <br /> p L.E.L. READING AT REMOVAL (MUST B C 20%) <br /> ° T ; c.ecS36 + rT R COMMENTS do <br /> A Sgi L. 14 ihs <br /> N TANK MATERIAL TEFL IBERGLASS, OTHER) I TANK SIZE alb' J /S <br /> K C <br /> / 0 TANK CONDITION (GOO POOR HOLES) <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T t <br /> F A cd_" � <br /> I N VLl <br /> E K <br /> L <br /> D EXCAVATION SIZE: X 4L X YDS OF SOIL: -x 3 <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 /> 0moDEPTH TO G.W. : FT SAMPLING METHOD <br /> N # OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: <br /> Hi LABORATORY: C SAMPLERS NAME: <br /> i <br /> CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> 'If 2"f 013(7/8R) <br />