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SJLHU - UNDERGR'"IND TANK CLOSURE/A4ANDONHEt'- INSPECTION <br /> (SHADED AREA 7 BE FILLED IN FOR 711E FIRS_..iANK ONLY) <br /> Al�l ci c <br /> G OWNER NAME SPM'l� OWNER PHONE # <br /> E <br /> N CONTRACTOR ,tggv Mt-6VL- CON. PHONE# <br /> E <br /> R SJLH PERMIT # EPA # �4�3 FIRE PERMIT # C5 <br /> L <br /> L <br /> INSPECTOR Jl �1 DATE u12-0�0 + TANK # 39 <br /> R RINSED Y/0) METHOD '1 to RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE ,�� ��� <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y N) METHODLn� CQ AMOUNT USED <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 203) N` <br /> 0 3 <br /> •1 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL. C(STEEL) FIBERGLASS, OTHER) TANK SIZE (OCCQ <br /> K C <br /> / 0 TANK CONDITIONJ OOR HOLES) r16 DfXr2r` 0�5 <br /> P N _ ('i (n� C(SYYD LIQ✓� <br /> I S PIPE MATERIAL (STEEL FIBERGLASS, OTHER) I FEET <br /> P T <br /> i PIPING CONDITION (GOOD, POOR HOLES) C��r�iicvi 2J C�e�� <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> � T <br /> F A QD0�,7 T PrnbtiD cr'N <br /> I N <br /> E K f ° <br /> L <br /> D EXCAVATION SIZE: X -L4- 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 ){ DEPTH TO G.W. : �� ° T SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> aOTHER SAMPLE: NI � <br /> LABORATORY: SAL in)fF SAMPLERS NAME: 4-. <br /> LIE CLOSURE IN PLACE MIXTURE: Nr(a VOLUME: fv) o <br /> DRAW SITE MAP ON REVERSE <br />