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SJLHD - UNDERGROUND TANK CLOSURE/ABANDONMENT INSPECTIUN <br /> (SHADED AREA 9 BE FILLED IN FOR THE FIP TANK ONLY) <br /> MINI <br /> 5. (��L <br /> G OWNER (NAME 0019 vU 4 OWNER PHONE # 70=f <br /> E <br /> N CONTRACTOR J CON. PHONE# <br /> E ' <br /> R < SJLHD PERMIT IR EPA # FIRE PERMIT # <br /> A VM Him <br /> L <br /> INSPECTORY�5 ' /-- DATE cd �( TANK # 39 - �� - / <br /> R RINSED (Y D N) METHOD - RINSE AMOUNT ,) - I <br /> I <br /> N RINSATE DISPOSAL SITE CALL (3-ev lLtceq� <br /> S 0,17 g< vim- - <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED /N) METHOD p UQy �C�� AMOUNT USED <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) /(/�/4 <br /> O <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL ST E ; FIBERGLASS, OTHER) TANK SIZE `opp <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES ) N c <br /> P N <br /> I S PIPE MATERIAL STEEL FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, S) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A <br /> I N <br /> E Kn� N c f� u� J Nara`D a errE d <br /> L <br /> D EXCAVATION SIZ X 2�/' 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 IL <br /> I <br /> 0 H DEPTH TO G.W. : A/ONFT SAMPLING METHOD <br /> N 2 �- <br /> 0 # OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: <br /> LABORATORY: (� ' /(J4525ly✓> <br /> SAMPLERS NAME: -� <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />