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SJLliD - UNDE tOUND 'TANK CLOSURE/AfVMDON'i' INSPEC'TIUN <br /> (SHADED ARE. TO BE FILL ED I14 FOR THE !.,' T TANK ONLY) <br /> = <br /> � <br /> u <br /> t <br /> mm <br /> G OWNER ME OWNER PHONE <br /> E <br /> N { CONTRACTOR CON. PHONE# <br /> E <br /> R :i SJLHD PERMIT # EPA # FIRE PERMIT # <br /> INSPECTOR DATE ' LTANK # 39 -1- 59" 1 f ' - <br /> R RINSED (Yo__ <br /> METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E I MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y N) METHOD AMOUNT OgD <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> O <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL STEE FIBERGLASS, OTHERS TANK SIZES* <br /> K C <br /> / 0 TANK CONDITIO 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 /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A <br /> E K <br /> L <br /> D EXCAVATION SIZE: rs X X 5, YDS OF SOIL: <br /> S- <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <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 /> r <br /> 0 H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> F-0] <br /> OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> _j <br /> �Lj CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> Ell 2;1 04.1(7/88) ; <br />