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SJLHD - UNDERGROUND TANK CLOSURE/ABANDONMENT INSPECTION <br /> (SHADED AREA BE FILLED IN FOR THE F I RA& TANK ONLY) <br /> { 4 <br /> D C <br /> G OWNER NAME k)e 5 D OWNER PHONE # <br /> E <br /> N CONTRACTO r e- O , CON. PHONE# l��� - �5sv <br /> E <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # 00 `. <br /> A <br /> L <br /> INSPECTOR DATE TANK # 39 - �� - 19 _ <br /> R RINSED (Y N METHOD RINSE AMOUNT I� <br /> I P <br /> N RINSATE DISPOSAL SITE i <br /> S <br /> E I MANIFEST # -OR- OTHER <br /> V VAPORS PURGED Y N) METHOD �., AMOUNT USEE ,, 3 <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST E < 20$) <br /> O <br /> T R COMMENTS <br /> N TANK MATERIAL (STEEL, BE GLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES ) S <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET / <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES). �! •S/ <br /> N 77- SAMPLE # <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T <br /> F A <br /> uno <br /> I N Gt t ,,eD� <br /> E K G <br /> L / 3 <br /> D EXCAVATION SIZE: X � X YDS OF SOIL : u a 0 GCS <br /> S- SAMPLE # <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P <br /> S P I <br /> P L P <br /> E I E <br /> C N YDS OF SOIL <br /> T G TRENCH DIMENSION X X <br /> I <br /> 0 H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> r—oll OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />