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SJLHD - UND' 'GROUND 'TANK CLOSURE/AI(ANDC`ALNT INSPECTION <br />(SHADED AR*,„ TO BE FILLED IN FOR THE 1,moOST TANK ONLY) <br />ME �.GMn iS 1"x <br />�%(oi... C''lLI. CiADD`ln_ / —%9s'n I��.� lJ Al Al'r.Yi <br />G <br />OWNE IAME <br />WdLA <br />OWNER PHONE tl aoti y�� _ j�� 7 <br />E <br />N <br />CONTRACTOR ) <br />CON. PHONE# <br />E <br />R <br />< SJLHD PERMIT tl EPA I FIRE' # <br />Lm�N��AR <br />PERMIT <br />INSPECTOR` <br />DATE-/yG <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) <br />METHOD AMOUNT USED <br />A <br />P <br />L.E.L. READING AT REMOVAL (MUST BE C 20%) <br />T <br />O <br />R <br />COMMENTS <br />A <br />N <br />TANK MATERIAL (STEEL, FIBERGLASS, OTHER) <br />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 /># FEET <br />P <br />T <br />I <br />PIPING CONDITION (GOOD, POOR, HOLES) <br />N <br />G <br />DEPTH SOIL TYPE OBSERVATION SAMPLE I <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 />s: <br />I <br />A <br />DEPTH SOIL TYPE OBSERVATION <br />SAMPLE tl <br />N <br />M <br />P <br />S <br />P <br />I <br />P <br />L <br />P <br />E <br />E <br />I <br />C <br />N <br />T <br />G <br />TRENCH DIMENSION X X <br />YDS OF SOIL <br />I <br />0H <br />DEPTH TO G.W.: FT <br />SAMPLING METHOD <br />N <br />2 <br />0 <br />tl OF HOURS SINCE DEWATERING: <br />OTHER SAMPLE: <br />HFO-11 <br />LABORATORY: <br />SAMPLERS NAME: <br />CLOSURE IN PLACE <br />MIXTURE: <br />VOLUME: <br />DRAW SITE MAP ON REVERSE <br />1?11 23 01'1(7/88) <br />