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SJLHD - UNDERGROUND 'TANK CLOSURE/A $ANDONMLNT INSPEC'1' lUN <br /> ( SHADED AREA TO BE FILLED IN FOR T1{E FIRST TANK ONLY ) <br /> Mblof 081117 9 an <br /> 011111 I'llp!1, 111111 <br /> E + OWNER NAME LPais Slu // v / OWNER PHONE II <br /> 5Y <br /> N + CONTRA ORb� �� s ON . PHONE1 `� � � — � 3 �a <br /> E < <br /> R SJLH PERMIT EPA 1 C +Ac000sb6 bcIRE PERMIT <br /> INSPECTOR CJ O DATE off/ I TANK 1 39 - � c( <br /> R RINSED *N ) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST 1 -OR - OTHER <br /> V VAPORS PURGED /N ) METHOD � �� AMOUNT USED <br /> A <br /> P L . E . L . READING AT REMOVAL ( MUST BE < 203 ) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIALFIBERGLASS , OTHER ) TANK SIZE orb O <br /> K C <br /> / 0 TANK CONDITION ( GOOD , OOR HOLES ) <br /> P N <br /> . 1 8 PIPE MATERIAL FIBERGLASS OTHER ) 1 FEET <br /> P T <br /> I PIPING CONDITION ( GOOD , ( DOR , HOLES ) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE Y <br /> T , s « P �ti n1 <br /> F A <br /> I N " <br /> E K <br /> L <br /> D EXCAVATION SIZED � �X j X // YDS OF SOIL : <br /> 3 : <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE M <br /> N M P <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> TG TRqNCH DIMENSION X X YDS OF SOIL <br /> I <br /> O ' H DEPTH TO C . W . : FT SAMPLING METHOD <br /> N 2 1 1' <br /> 0 1 OF HOURS SINCE DEWATERING : <br /> ❑O OTHER SAMPLE : <br /> LABORATORY : `GL SAMPLERS NAME : <br /> CLOSURE IN PLACE MIXTURE01 VOLUME : <br />