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SJLHD - UND' 3ROUND 'TANK CLOSURE/AIJANDC 'ENT INSPECTION <br />(SHADED AR`L!G TO BE FILLED IN FOR THE FTOST TANK ONLY) <br />DRAW SITE MAP ON REVERSE <br />ill "t '),Iu("!88) <br />Ila <br />G <br />< OWNER NAME • OWNER PHONE aoy <br />�� <br />E <br />N <br />CONTRACTOR CON. PHONE# <br />E <br />R <br />SJLHD PERMIT M # FIREE PERMIT Y <br />; <br />7E�P'�Ai <br />L..It�MR <br />INSPECTOR <br />DATE <br />TANK Y 39 <br />R <br />RINSED (Y/N) METHOD RINSE AMOUNT <br />I <br />N <br />RINSATE DISPOSAL SITE <br />S <br />E <br />MANIFEST I -OR- OTHER <br />V <br />VAPORS PURGED (Y/N) METHOD AMOUNT USED <br />A <br />P <br />L.E.L. READING AT REMOVAL (MUST BE < 208) <br />T <br />0 <br />R <br />COMMENTS <br />A <br />N <br />TANK MATERIAL (STEEL, FIBERGLASS, OTHER) <br />TANK SIZE <br />K <br />C <br />/ <br />O <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 SOIL TYPE OBSERVATION SAMPLE tl <br />T <br />F <br />A <br />I <br />N <br />E <br />K <br />L <br />R <br />D <br />EXCAVATION SIZE: ,.,�X J'X of <br />YDS OF SOIL: <br />3: <br />I <br />A <br />DEPTH SOIL TYPE OBSERVATION <br />SAMPLE M <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 />I <br />0H <br />DEPTH TO G.W.: FT SAMPLING METHOD <br />N <br />2 <br />0 <br />@ OF HOURS SINCE DEWATERING: <br />❑O <br />OTHER SAMPLE: <br />LABORATORY: SAMPLERS NAME: <br />IE CLOSURE IN PLACE I MIXTURE: <br />VOLUME: <br />DRAW SITE MAP ON REVERSE <br />ill "t '),Iu("!88) <br />