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SJLHD — UNDEW 'IND 'TANK CLOSURE/A1IANUONMf'' 1N!;PECTlUN <br /> (SHADED AREA E FILLED IN FOR THE FIRE PANK ONLY) <br /> t f <br /> .� � <br /> Millrl. <br /> ' f <br /> G r OWNER NAME OWNER PHONE I <br /> ,�tom <br /> N t CONTRACTOR CON. PHONE# <br /> R SJLHD PERMIT 1 EP4. ,FIRE PERMIT M •i•^ �''� <br /> L <br /> INSPECTOR 1<t DATE TANK 39 <br /> R RINSED `(l�` ) METHOD— RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S � <br /> E MANIFRST I -OR- OTHER <br /> V VAPORS PURGED ( N) METHOD"Vr AMOUNT USED <br /> A <br /> P G.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> O �- <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL '5Th L, FIBERGLASS, OTHER) TANK SIZE-71 <br /> K C <br /> / 0 TANK CONDITION (C�OO , POOR, HOLES) <br /> P N <br /> I S PIPE MATERIALTEE FIBERGLASS, OTHER) I FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE I <br /> T 4 77, <br /> aAle <br /> I N �"h , Ti <br /> E K <br /> L / ZS �►�e / r <br /> D EXCAVATION SIZE: It X X YDS OF SOIL: <br /> S: <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE I <br /> N M P <br /> S P I <br /> P L P <br /> S I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> O H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 1 OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLyME: <br /> EH 23 043(7/8R) DRAV SITE HAP ON REVERSE <br />