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SJLHD - UNDERGROUND 'TANK CLOSURE/AL)AND "�MENT INSPECTION <br /> (SHADED A TO DE FILLED IN FOR THE JFRST TANK ONLY) <br /> OI• EsyffdN 103 klot,, 5 cr+ION <br /> i; <br /> G OWNER NAME OWNER PHONE # <br /> E C ' or rc i o N 2 38 -356G <br /> N CONTRACTOR .) 1 I CON. PHONE# ,. _7_5,q Igoe <br /> E T <br /> R SJLHD PERMIT p EPA I FIRE PERMIT # j - _C)E <br /> Lit. . .; . .� 'I� f. - . . td <br /> t� C ^ IN LAC URY CLU5URR <br /> INSPECTOR / ( 1j,,,• DATE IZ11 Br� TANK p 39 - _ /y S'/ - <br /> I RINSED ) METHOD RINSE AMOUNT <br /> / YYS <br /> N RINSATE DISPOSAL SITEc-P /r. <br /> Sf��Yr/C3/3arl4 33 <br /> S <br /> E MANIFEST rs7Sti'3Tz- -OR- OTHER <br /> V VAPORS PURGED (Y/N) METHOD- AMOUNT USED r- - <br /> A �C lE✓ <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (kTE , FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / O TANK CONDITION GOODY POOR, HOLES) � , `✓./Pi <br /> P N - <br /> I S PIPE MATERIAL STEEL, FIBERGLASS, OTHER) # FEET /y <br /> P T <br /> I PIPING CONDITION000,POOR, HOLES) <br /> N K..- <br /> G DEPTH S91I. TYPE OBSERVATION SAMPLE # <br /> F A 3 `-: :✓ - ,. Ce .�/h r� ri- <br /> E K <br /> L <br /> DEXCAVATION SIZE: [Z` X �, X F SOIL:<� YDS O 7 <br /> s: <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE p <br /> N M P <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION <br /> I X X YDS OF SOIL <br /> 0 H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> aOTHER SAMPLE: <br /> LABORATORY: �p� V�� , �.y�,� SAMPLERS NAME:RCI <br /> i G <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON gEVCRSE <br />