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SJLHD — UN tGRUUND 'TANK CLOSURE/AItAN MENT INSPEC'1IlUN <br /> (SHADED ATO BE FILLED IN FOR *RST TANK ONLY) <br /> G OWNER NAME OWNER PHONE q <br /> E <br /> N CONTRACTOR ! <br /> E CON. PHONEM <br /> s? <br /> R SJLHD P RMIT q EPA I <br /> LFIRE PERMIT q <br /> � <br /> INSPECTOR l: Lr DATE ��I., TANK q 39 n ' <br /> R RINSED /N) METHOD /] <br /> I Kit RINSE AMOUNT (-�PL <br /> N RINSATE DISPOSAL SITE <br /> S �i(- �Cnt_wr l <br /> E MANIFEST I -OR- OTHER <br /> V VAPORS PURGED Y N) METHOD <br /> A 1(( AMOUNT USED�D <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) J <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERI (STE , FIBERGLASS, OTHER) TANK SIZE <br /> K C ZC � L <br /> / O TANK CONDITION (GOOD PO <br /> P N OR HOLES) Q er�o5 U� �✓iOc <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) q FEET �i�`r� Y1o•t- M <br /> P T pis tr <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE q <br /> F A <br /> I N QFh t ' <br /> E K k <br /> L <br /> D EXCAVATION SIZE: Q gg, ���" <br /> S- �`]�- X —LL.— X c� YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE q <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 DEPTH TO G.W. : jLv-w FT SAMPLING METHOD , <br /> N 2 - <br /> 0 q OF HOURS SINCE DEWATERING: - <br /> aOTHER SAMPLE: <br /> LABORATORY: FG.L SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />