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SJLHD - UNDERGROUND TANK CLOSURE/ABANDONMENT INSPECTION <br /> (SHADED AREA I BE FILLED IN FOR THE FIR TANK ONLY) <br /> RzR/} 's L SX <br /> G OWNER NAME 7�4U/_ iHAZLE R✓� OWNER PHONE # �aay, �f(a6_9ra� <br /> E !✓ CON. PHONE# <br /> N CONTRACTOR lt,{2s�'er r� Vlleter Caoy) 958-(0/07 <br /> E <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # �� v /0 <br /> A <br /> L <br /> INSPECTOR DATE TANK # 39 - /oa C <br /> R RINSED (Y METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED ON) METHOD AMOUNT USED /s <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST E < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIA (STEEL, FIBERGLASS, OTHER) TANK SIZE a 7� <br /> K C <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES ) 7 S O <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> NSAMPLE # <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T <br /> F A <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: X _ X YDS OF SOIL: <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 /> 0 H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> HECLOSURE IN PLACE MIXTURE: 'cRErF y VOLUME: 3 <br /> S c�5/u�/ <br /> DRAW SITE MAP ON REVERSE <br />