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SJLHD — UNDERGROUND TANK CLOSURE/ABANDONMENT INSPECTION <br />(SHADED AREA BE FILLED IN FOR THE FIRS' TANK ONLY) <br />DRAW SITE MAP ON ttNERSE <br />r <br />(NAME <br />DAF �� <br />G <br />OWNER <br />Sl <br />OWNER PHONE # <br />l <br />E <br />N <br />CONTRACTOR <br />/ <br />CON. PHONE# A1C- <br />E <br />R <br />SJLHD PERMIT # (� PA # FIRE PERMIT # <br />A <br />L <br />INSPECTOR <br />DATE l <br />TANK # 39 <br />R <br />RINSED (Y N ME HO <br />RINSE fj�jNT <br />I <br />N <br />RINSATE DISPOSAL SITE �, <br />Q <br />S <br />E <br />MANIFEST # -OR- OTHER <br />V <br />VAPORS PURGED (Y N) <br />METHOD c 0 <br />AMOUNT USED/So <br />A <br />P <br />L.E.L. READING AT REMOVAL (MUST BE < 20$) <br />T <br />0 <br />R <br />COMMENTS _ <br />A <br />N <br />TANK MATERIAL (STEEL FIBERGLASS, OTHER) <br />TANK SIZE Oho <br />K <br />/ <br />C� <br />0 <br />- <br />TANK CONDITION' 16606,- POOR, HOLES) <br />P <br />N <br />I <br />S <br />PIPE MATERIAL STEEL FIBERGLASS, OTHER) <br /># FEET <br />P <br />T <br />I <br />PIPING CONDITION (GOOD, OR, HOLES) <br />N <br />G <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />T <br />, <br />F <br />A <br />/ n <br />I <br />N <br />E <br />K <br />L <br />D <br />EXCAVATION SIZE: X jj)— X <br />YDS OF SOIL: <br />I <br />S- <br />A <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />N <br />M <br />P <br />QJ <br />S <br />P <br />I <br />LA -1011 <br />P <br />L <br />P <br />E <br />I <br />E <br />C <br />T <br />N <br />G <br />TRENCH DIMENSION X X <br />YDS OF SOIL <br />0 <br />H <br />DEPTH TO G.W.: FT <br />SAMPLING METHODl�v,� <br />L <br />N <br />2 <br />0 <br /># OF HOURS SINCE DEWATERING: <br />r <br />07 10 OTHER SAMPLE: <br />L—LJABORATORY: SAMPLERS NAME: <br />CLOSURE IN PLACE <br />MIXTURE: <br />VOLUME: <br />DRAW SITE MAP ON ttNERSE <br />r <br />