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SJLNu - UNDERGliUJND TANK CLOSURE/AB,ANDONMENT INSPEC'I'ION <br /> (SHADED AR TO BE FILLED IN FOR THE F" ST TANK ONLY) <br /> M v { SFti - <br /> G < OWNER (NAME ( .O.S. 446c Wc(ICS OWNER PHONE # �(�}C}-�a�_9 <br /> E ' <br /> N < CONTRACTOR t � Ua Ctiv �'�� CON. PHONE# ^ $� <br /> R < SJLHD PERMIT # EPA # FIRE PERMIT # �. �. <br /> " A t-' <br /> L <br /> INSPECTOR LL DATE TANK # 39 - - <br /> R RINSED (Y METHOD - RINSE AMOUNT <br /> I -- <br /> N <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (YN) METHOD' -/ (CE AMOUNT USED <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIA (STEE , FIBERGLAS THER) TANK SIZE J.5-Do C� <br /> K C <br /> / 0 TANK CONDITION (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 I Y. ✓a <br /> I N <br /> E K ✓to 05 o✓ �N 9f - c <br /> L <br /> YDS OF SOIL : <br /> D EXCAVATION SIZE: Xr= X�_� <br /> r we4=, Ury %r - <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 0 'SOIL - <br /> I <br /> OmoDEPTH TO G.W. : nO ��YP SAMPLING METHOD <br /> N # OF HOURS SINCE DEWATERING: <br /> LH[ OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: ` <br /> CLOSURE IN PLACE MIXTURE: �- VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />