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SJLHD — UIJDL:RGROUND TANK CLO:;URE/AILANDONIIENT INSPEC:'!'IUN <br /> (SHADED AR TO BE FILLED IN FOR THE 01 dalum iST TANK ONLY) <br /> M TIT, <br /> G OWNER 'NAME ?? <br /> E <br /> OWNER PHONE # ; <br /> N CONTRACTOR ��: CON. PHONE# ' <br /> E <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> `� <br /> LINSPECTOR � - DATE S/29 TANK # 39 ( w 0'3 <br /> R RINSED ( N) METHOD <br /> I RINSE AMOUNT /Q <br /> = <br /> N RINSATE DISPOSAL SITE <br /> S on <br /> E MANIFEST 9 -OR- OTHER <br /> A VAPORS PURGE (Y N) METHOD <,� AMOUNT USED <br /> ve i <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A . <br /> N TANK MATERIAL ( TEEL, FIBERGLASS OTHER) TANK SIZE <br /> K C S �D <br /> / 0 TANK CONDITION GOOD POOR, HOLES) <br /> P N <br /> I S PIPE MATERIAL, TEE FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F ASi C_ o 0Cf0, ar t.� rcv 06:5 <br /> t'/ti?c YID <br /> I N ' lue a,c/, a/cx+�Tevs <br /> E K <br /> L <br /> D EXCAVATION SIZE: _ X � X 1L YDS OF SOIL: So <br /> 3; <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M SAMPLE # <br /> p <br /> S P I ! e 071 <br /> P . L P 01 0 <br /> E I E <br /> C N ' <br /> T C TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> 0 H ' DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 -- <br /> 0 - # OF HOURS SINCE DEWATERING: <br /> 07 OTHER SAMPLE: <br /> LABORATORY: � . SAMPLERS NAME: <br /> .. ! �crrk c� <br /> I' CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />