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E <br />SJLHD - UND' 'GROUND 'TANK CLOSURE/AIjANDC LENT INSE'EC'P1UN <br />(SHADED AR%%. TO BE FILLED IN FOR T1)G 1•w -CST TnnK uNLr) <br />II �F,SLYatJ!V1!J``if'"`i'�i",'�i`1%i�`�N`l.`1;�7�4''l�:yCy(::if:f.:I.:ltxuu:ic[.;�:r.:ru.•r::::u:. <br />I ^ TE r+ 4aaaarmrn m�oY/J6]FlFEIF1�'EY�1�2C <br />oA�CDIi <br />G <br />E <br />: OWNERl1fN,AME <br />OWNER PHONE I <br />N <br />E <br />CONTRACTOR <br />CON. PHONE# <br />R <br />L.. <br />< SJLHD FIRE PER <br />PERMIT I EPA I MIT I <br />..... ..... .. .. ,.,.....f..... I' " <br />INSPECTORI-) <br />DATE / <br />TANK 1 39 <br />R <br />I <br />RINSED (Y/l RINSE AMOUNT <br />N <br />S <br />RINSATE DISPOSAL SITE <br />E <br />MANIFEST I -OR- OTHER <br />V <br />A <br />VAPORS PURGED (Y/N) <br />METHOD <br />AMOUNT USED <br />P <br />O <br />L.E.L. READING AT REMOVAL (MUST BE < 20%) <br />T <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 />I 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 />2 <br />D <br />EXCAVATION SIZE: �(YX S�) X �� <br />YDS OF SOIL: <br />s: <br />I <br />A <br />DEPTH SOIL TYPE OBSERVATION <br />SAMPLE I <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 YDS OF SOIL <br />I <br />O <br />H <br />DEPTH TO G.W.: FT <br />SAMPLING METHOD <br />N <br />2 <br />0 <br />I OF HOURS SINCE DEWATERING: <br />OTHER SAMPLE: <br />HFO-11 <br />LABORATORY: SAMPLERS NAME: <br />CLOSURE IN PLACE <br />I MIXTURE: <br />VOLUME: <br />DRAW SITE MAP ON REVERSE <br />E][ 21 043(7/88) <br />