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SJLHD - UNDERGROUND TANK CLOSURE/ABANDONMENT INSPECTION <br /> (SHADED AREA 0 BE FILLED IN FOR THE FII TANK ONLY) <br /> 11191291131! OF 1111111�101:: :11 :1!1: <br /> Ditl <br /> G OWNER 'NAME NoeVO �/tSN/l�} OWNER PHONE # CZ�> �3 <br /> E <br /> N CONTRACTOR-J-_ /`- <br /> 1m -j4or-pt CON. PHONE# (Z0S) 4IOZ- <br /> E <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # 3 <br /> A <br /> L 2 <br /> INSPECTOR DATE Ij TANK # 39 <br /> R RINSED ( METHOD-�r-, Le ,��j, RINSE AMOUNT <br /> I <br /> 3 RINSATE DI POSAL SITE <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y METHOD AMOUNT USED <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES ) <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G TYPE OBSERVATION SAMPLE # <br /> T <br /> F A <br /> I N <br /> E K <br /> L <br /> D EXCAFATION SIZE: X _ X YDS OF SOIL: <br /> S - <br /> I A DEPTH SOIL TYPE TION 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 SOIL <br /> I <br /> 0 H DEPT FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE:C ,� ✓ VOLUME: S <br /> DRAW SITE MAP ON REVERSE <br />