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SJLHD - UND -ROUND TANK CLOSURE/AIIANDC//ENT INSPECI'10N <br />(SHADED AR�% TO BE FILLED IN FOR THE FZ,.,,ttST TANK ONLY) <br />DRAW SITE MAP ON REVERSE <br />EI( 2:1 ,R) <br />Af <br />G <br />E <br />OWNER IJAME ,OWNER <br />PHONE #(.Q pR C� �a - L5 97 <br />N <br />< CONTRACTOR ) <br />CON. PHONE# <br />E <br />R <br />SJLHD PERMIT tl EP'A� I FIREE P^E�RMIT q <br />INSPECTORT/ / <br />DATE a iV <br />TANK 1 39 - <br />RINSED (Y/N) METHOD RINSE AMOUNT <br />I <br />N <br />S <br />UER <br />RINSATE DISPOSAL SITE <br />MANIFEST I -OR- OTHER <br />VAPORS PURGED (Y/N) METHOD AMOUNT USED <br />nR <br />L.E.L. READING AT REMOVAL (MUST BE < 20%) <br />T <br />COMMENTS <br />N <br />TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br />K <br />C <br />/ <br />0 <br />TANK CONDITION (GOOD, POOR, HOLES) <br />P <br />N <br />I <br />S <br />PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) <br />Y FEET <br />P <br />T <br />I <br />PIPING CONDITION (GOOD, POOR, HOLES) <br />N <br />G <br />DEPTH <br />SOIL TYPE OBSERVATION SAMPLE Y <br />T <br />F <br />A <br />I <br />N <br />E <br />K <br />L <br />D <br />EXCAVATION SIZE: X — X <br />YDS OF SOIL: <br />3- <br />I <br />A <br />DEPTH SOIL TYPE OBSERVATION <br />SAMPLE Y <br />N <br />M <br />P <br />S <br />P <br />I <br />P <br />L <br />P <br />E <br />I <br />E <br />C <br />N <br />T <br />G <br />TRENCH DIMENSION X _ X <br />YDS OF SOIL <br />I <br />0 <br />H <br />DEPTH TO G.W.: FT <br />SAMPLING METHOD <br />N <br />2 <br />0 <br />1 OF HOURS SINCE DEWATERING: <br />❑O <br />OTHER SAMPLE: <br />LABORATORY: Cy l <br />SAMPLERS NAME: <br />CLOSURE IN PLACE <br />I MIXTURE: <br />VOLUME: <br />DRAW SITE MAP ON REVERSE <br />EI( 2:1 ,R) <br />