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SJLHD - UNDERGROUND TANK CLOSURE/A4,4NDONMENT INSPECTION <br />(SHADED!ARlb TO BE FILLED IN FOR 7'HE <br />DRAW SITE MAP ON REVERSE <br />T TANK ONLY) <br />}�. <br />. .S <br />G <br />< OWNER NAME 1� �CG <br />OWNER PHONE # <br />CONTRACTOR ge)rd_~ �2 <br />CON. PHONE# <br />E <br />R <br />A1. <br />< SJLHD PERMIT # EPA # FIRE PERMIT # 3 <br />L <br />INSPECTOR DATE TANK # 39 - 11( <br />x� <br />R RINSED (Y`Nj) <br />METHOD RINSE AMOUNT <br />I <br />N <br />RINSATE DISPOSAL SITE <br />S <br />E <br />MANIFEST # -OR- OTHER <br />V <br />VAPORS PURGED (Y N) <br />METRO <br />AMOUNT USED <br />A <br />3 <br />L.E.L. READING AT REMOVAL (MUST(iE < 20$)<Ej <br />OP <br />O <br />T <br />R <br />COMMENTS <br />A <br />N <br />K <br />C <br />TANK MATERIALTEE FIBERGLASS, OTHER) <br />TANK SIZE <br />/ <br />0 <br />TANK CONDITION (GO <br />OOD POOR HLES)i <br />fe <br />P <br />N <br />L(S ti r/jS% <br />I <br />S <br />PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) <br /># FEET <br />P <br />T <br />I <br />PIPING CONDITION (GOOD, POOR, HOLES) <br />fe <br />N <br />�s <br />G <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />T <br />F <br />A <br />I <br />N <br />E <br />K <br />L <br />1-/V& <br />l 7/ d c a e 1J7 <br />D <br />EXCAVATION S ZE: X�L� X <br />YDS OF yOIL: <br />S- <br />— <br />I <br />A <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />N <br />M <br />P <br />S <br />P <br />I <br />P <br />L <br />P <br />E <br />I <br />E <br />C <br />N <br />T <br />G <br />TRENCH DIMENSION XX YDS OF SOIL <br />I <br />— <br />0 <br />H <br />DEPTH TO G.W.: FT SAMPLING METHOD <br />N <br />2 <br />0 <br /># OF HOURS SINCE DEWATERING: <br />Fol <br />OTHER SAMPLE: <br />wLABORATORY: <br />Cervi fl7�Q <br />SAMPLERS NAME: <br />��777PLACE <br />MIXTURE: <br />VOLUME: <br />DRAW SITE MAP ON REVERSE <br />