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SJLHD — UNDLI%'GROUND TANK CLOaURE/!RAND(`HUNT I.NSPECTIUN <br /> (SHADED AI'' TO BEFILLED IN FOR THE 2STA <br /> T NK ONLY) <br /> G < OWNER NAME OWNER PHONE AT' <br /> E <br /> N CONTRACTOR CON'. PHONE ' <br /> E <br /> R r SJLHD PERMIT 0 EPA I FIRE PERMIT # ; <br /> � � . . . <br /> � . . . . - <br /> INSPECTOR C DATE �, TANK 0 39 <br /> R RINSED (Y N) METHODRINSE AMOUNT ! Tl ' I <br /> I c. f� list cvc S 1 <br /> N RINSATE DISPOSAL SITE <br /> S Ser t!i C74 <br /> E MANIFEST # -OR- OTHER <br /> VA VAPORS PURGED �N} METHOD r AMOUNT USED as <br /> -2a lbs to <br /> . P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> O <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL FIBERGLASS, OTHER) TANK SIZE <br /> K c 3"00 o <br /> / O TANK CONDITION {GOOD POOR, HOLES) <br /> P N <br /> ` IIT PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) I FEET <br /> J ��(C <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> T <br /> F A 1 ci ,- ►vo ,iorctflo�.s '� ori <br /> IN r <br /> E K <br /> L <br /> D EXCAVATION SIZE: ? X X IL YDS OF SOIL: <br /> s- <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> N M p. <br /> S P I cr Nd /,o <br /> P L P �•y,. o c� "Nn rsc to;z �id.�. <br /> E I E,. `8 ` 5� Cca^riw+ -ys ..n!.` G <br /> C N <br /> T G TRENCH DIMENSION /I X � X <br /> I z YDS OF SOIL 23 <br /> 0 H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 -- <br /> 0 A OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: <br /> LABORATORY: LQ _9yz �1S SAMPLERS NAME: <br /> - !0,/L <br /> Ll CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> -JII <br /> DRAW SITE MAP ON REVERSE <br />