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SJLHD - UNDERGROUND TANK CLQ:;URE/AllAND("'MENT ,INSPECTION <br /> (SHADED A TO HE FILLED IN FOR THE ?ST TAN <br /> ���� �?������� � K ONLY) <br /> G OWNER NAME OWNER PHONE <br /> E <br /> N CONTRACTOR CON. PHONE ` ~ <br /> E <br /> R < SJLHD PERMIT IEPA FIRE PERMIT # , <br /> A <br /> { <br /> INSPECTOR � UtiF DATES 251 / : TANK 1 39 <br /> R RINSED ON) METHOD RINSE 'AMOUNT <br /> I Prescwel s� 3oa <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST -OR- OTHER <br /> V VAPORS PURGED �) METHODS AMOUNT USED �o� � <br /> A t <br /> . P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> O <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL TEE , FIBERGLASS, OTHER) TAA`K SIZE <br /> K C �0 eon <br /> / O TANK CONDITION {GOOD POOR, HOLES) <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS <br /> P T , OTHER) FEET <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE 0 <br /> T <br /> F A (14 <br /> od ic�N o �r pOD� Nay <br /> I N _r ��rd.J d&srrvt�l OG4� <br /> E K <br /> L <br /> D 3- EXCAVATION SIZE: X X YDS OF SOIL: <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 OF SOIL <br /> I <br /> O H <br /> N DEPTH TO G.W. : FT SAMPLING METHOD <br /> 2 <br /> 0 p OF HOURS SINCE DEWATERING: <br /> OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> c <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> 1'ff 2'f 04" /� j <br />