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SJLHD - UNDERGROUND 'TANK CLO: URE/AUNDONMENT INSPECTION <br /> (SHADED ARTO DE FILLED IN <br /> �� � N• . . . FOR THE T TANK ONLY) <br /> < <br /> . . <br /> Z <br /> v ., <br /> F-'- � <br /> G OWNER NAME1 r. 1 . .j [�...>4 iii✓c{ <br /> E J r. Co". OWNER PHONE q <br /> 6<'� <br /> -536% <br /> N CONTRACTOR r CON. PHONEM ' r <br /> E �/� <br /> R < SJLHD PERMIT @ �4c r�:�,� < <br /> L . . , . . . . . . , , . . . . . . EPA M FIRE PERMIT j% <br /> INSPECTOR r, N,�_,-/ DATE ANK 9 39 <br /> R RINSE N) METHODkn' C..•1 <br /> I uv / RINSE AMOUNT�u <br /> v ' <br /> N RINSATE DISPOSAL SITE k� I,,,e, <br /> S <br /> E MANIFEST I -OR- OTHER <br /> V VAPORS PURGED tYN) METHOD <br /> A �j, j n AMOUNT USED �- <br /> J/! <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> NC TANK MATERIAL((STEELd FIBERGLASS, OTHER) <br /> K TANK SIZE 1 �)(lo <br /> / 0 1 TANK CONDITION (GOOD, POOR, HOLES) <br /> P N <br /> I S PIPE MATERIAL((STEE <br /> P T FIBERGLASS, OTHER) # FEET <br /> I PIPING CONDITION (Go0 <br /> N - POOR, HOLES) <br /> W. � G6sFr:v2 <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE Y <br /> E � < <br /> K <br /> L <br /> D EXCAVATION SIZE: X X YDS OF SOIL : <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE Y <br /> S P I <br /> P L p <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X <br /> I YDS OF SOIL <br /> 0 H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 Y OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: � � SAMPLERS NAME:;/ y, <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br /> ir1( L1•, 0,„• ,,, /88) DRAW SITE MAP ON REVERSE <br />