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SJLHD - UNV-''RGROUND 'TANK CLO:;URE/ALJAN[ LENT INSPECTION <br /> (SHADED At TO DE FI LLED .1H FOR THE ti,?ST TANK ONLY) <br /> G <br /> ' OWNER NAME OWNER PHONE # <br /> E ' <br /> N CONTRACTOR CON. PHONE# ' <br /> E <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> L .. ` . : : <br /> INSPECTOR C UN DATE �� TANK # 3 9 - /O/-j _ :_ <br /> I 4,7i6 <br /> RINSED Y ) METHOD • RINSE AMOUNT <br /> /N <br /> N RINSATE DISPOSAL SITE <br /> S <br /> ' E MANIFEST # -OR- . OTHER <br /> VA VAPORS PURGED ( N) METHODc� AMOUNT USED <br /> .P L.E.L. READING AT REMOVAL (MUST BE < 20%) Nfi <br /> O <br /> T R COMMENTS N <br /> A <br /> N TANK MATERIALSTEEL, FIBERGLASS, OTHER) TANK SIZE / d® <br /> K C <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES) <br /> P N I%/' /vv <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET 'S//^' ' <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A Ph►o S — No -fpi.� <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: -� X X YDS OF SOIL: <br /> 3 5' o/T <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <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 /> O H DEPTH TO C.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> FID OTHER SAMPLE: <br /> FLABORATORY:-- , /1/0 4r*eN SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: <br /> FVOLUME: <br /> VU 21 04" /8$) DRAW SITE MAP ON REVERSE <br />