Laserfiche WebLink
SJLHD - UNDERGROUND TANK CLOSURE/ABANDONMENT INSPECTION <br />(SHADED AREAMBE FILLED IN FOR THE FIRM TANK ONLY) <br />_ <br />u-.JU�u.�.�.�.�.a.�.�.•�.JU�.�.�.i tl. 1J:1:1.'l:Jt'l:l.'JL'.R:lJ':l.'l:lill:lArilui'iSi <br />DRAW SITE MAP ON REVERSE <br />4 <br />G <br />OWNER NAME OWNER PHONE # c�� z4 ��� _C) J��S- <br />h <br />E <br />N <br />CONTRACTOR T� M }�l�hr`���«H CON. PHONE# -ilio) Z <br />E <br />R <br />SJLHD,PERMIT # EPA # FIRE PERMIT # ), =P- <br />A <br />h <br />L <br />_ <br />INSPECTOR -6G,' -:z-, }-zAe­ <br />DATE <br />TANK # 39 <br />R <br />RINSED (Yo <br />METHOD <br />7 RINSE AMOUNT -" <br />I <br />N <br />RINSATE DISPOSAL SITE n <br />S <br />E 11 <br />MANIFEST # -OR- OTHER <br />V <br />VAPORS PURGED (Y� N) METHOD ��� j E AMOUNT USED � <br />A <br />P <br />L.E.L. READING AT REMOVAL (MUST BE < 20%) — <br />0 <br />T <br />R <br />COMMENTS <br />A <br />r -- <br />N <br />i TANK MATERIAL (STEEL, FIBERGLASS, OTHER) <br />TANK SIZE <br />K <br />/ <br />C <br />0 <br />TANK CONDITION,, (GOOD , POOR, HOLES) kc�57�4_RL-T C04--r,t3C,- IQ <br />- <br />P <br />N <br />_ <br />I <br />S <br />PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) <br /># FEET N'/ri <br />P <br />T <br />I <br />PIPING CONDITION (GOOD, POOR, HOLES) r <br />N <br />G <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />F <br />A <br /># <br />I <br />N <br />E <br />K <br />L <br />D <br />EXCAVATION SIZE: X 1_ X <br />c <br />YDS OF SOIL: <br />I <br />S_ <br />A <br />-- <br />`�Eg'I'Ffi -30IL-TY E OBSERVATION <br />-- <br />N <br />M <br />P <br />-- <br />S <br />P <br />I <br />P <br />L <br />P <br />_ <br />E <br />I <br />E <br />-- <br />C <br />T <br />N <br />G <br />TRENCH DIMENSION X - X <br />- <br />YDS OF SOIL <br />I <br />0 <br />H <br />DEPTH TO G.W.•FT <br />SAMPLING METHOD <br />N <br />2 <br />0 <br /># OF HOURS SINCE DEWATERING: <br />Mr—o—THERSAMPLE: <br />LABORATORY•SAMPLERS NAME: <br />_J: <br />CLOSURE IN PLACE <br />MIXTURE: - <br />VOLUME: <br />DRAW SITE MAP ON REVERSE <br />