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SJLND - UNDERGROUND TANK CLOSURE/ALIANDONMENT INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> 11 'umnum <br /> GG'/I7R Sw.-, �I7u�-/4°-i •'.SAO/S'- . <br /> G + OWNER NAME OWNER PHONE I <br /> E sines f rr u� �S8 -� V70 <br /> N CONTRACTOR Srylw CON. PHONEI <br /> E <br /> R SJLHD PERMIT I EPA �' AGOuSb?7G� FIRE PERMIT I <br /> L �` y� y <br /> INSPECTOR DATE - TANK 1 39 - <br /> R RINSED (YIN) METHOD + 1� RINSE AMOUNT 3� <br /> I <br /> N RINSATE DISPOSAL SITE <br /> 3 <br /> E MANIFRST I -OR- OTHER <br /> V VAPORS PURGED (,Y/N) METHOD �rQ AMOUNT USED/ <br /> A <br /> P L .E.L. READING AT REMOVAL (MUST BE C 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIALSTEE � FTBERGLASS, OTHER ) TANK SIZE ( ,� ,C6� <br /> K C - —. <br /> / O TANK CONDITION (GOOD, �O)Que OLF.S) <br /> P N <br /> I S PIPE MATERIAL ( TEE �� FIBERGLASSO OTHER) Y FEET <br /> P T �_ y <br /> I PIPING CONDITION (GOOD, OR <br /> f HOLES ) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE 1 <br /> T <br /> I N <br /> ,F <br /> E K <br /> L <br /> D EXCAVATION SIZE: =! X j_ X I � YDS OF SOIL : �pyd '> <br /> 3. <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE I <br /> N M P <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRF)NCN DIMENSION ?I X �-( X <br /> I I YDS OF SOIL <br /> 0 H DEPTH TO C.M. : FT SAMPLING METHOD <br /> N 2 <br /> 0 I OF (TOURS SINCE DEWATERING: <br /> 0 OTHER 5AMPLE' <br /> L <br /> IABORATORY: �.z 1� SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE:• VOLUME: <br />