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SJLHD - UN GROUND 'TANK CLOSURE/AIJAN ENT INSPECTION <br /> (SHADED A� TO BE FILLED IN FOR THEVST TANK ONLY) <br /> G <br /> -' OWNER NAME OWNER HONE # <br /> E 2 Q2- 23g - - <br /> N < CONTRACTOR CON. PHONE(1 <br /> E { �D sr a. 2 02 -6 3 -z2zF <br /> R i SJLHD PERMIT # EPA # FIRE PERMIT # <br /> L Mill if fifffm <br /> INSPECTO C �� DATE j,rTI F_TANK # 39 <br /> R RINSED ON) METHODRINSE AMOUNT <br /> - I <br /> N RINSATE DISPOSAL SITE <br /> S k'4'?" <br /> tYPG1S^,a.6 I 12{ nX�ctri r T�PIcL' <br /> E MANIFEST # /� 23� -OR- OTHER <br /> VAPORS PURGED (Y/N) METHOD AMOUNT USED <br /> FP.A <br /> L.E.L. READING AT REMOVAL (MUST BE t 20%) Qc) <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL FIBERGLASS, OTHER) TANK SIZE 6 <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 /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A t lu _ <br /> E c_ <br /> L <br /> D EXCAVATION SIZE: ZS X 2s X YDS OF SOIL: �0 <br /> 3- L �I <br /> _ <br /> I A DEPTH SOIL TYPE OBSERVATTnN SAMPLE # <br /> N M P r <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 /> ' O H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> ( 0 1 OF HOURS SINCE DEWATERING: <br /> E OIL OTHER SAMPLE: Qy-_ 37--_0L3 <br /> �� <br /> LABORATORY:2Q I erg+erc �^ <br /> • c� SAMPLERS NAME <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />