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SJLHD - UND"OGROUND 'TANK CLOSURE/AAAND0"4ENT INSPEC'TIUN <br /> (SHADED ARUe TO BE FILLED IN FOR THE ir„fST TANK ONLY) <br /> G OWNER NAME OWNER PHONE # } <br /> E 25'`1'7 <br /> N i CONTRACTOR CON. PHONE# <br /> R < SJLHD PERMIT # EPA # FIRE PERMIT #'-'f <br /> L � � `� °� <br /> INSPECTOR DATE 6 TANK # 39 <br /> R RINSEDN} METHOD �(� 'G r wc�s� RINSE AMOUNTS <br /> I <br /> N RINSATE DISPOSAL SITE Re-{;n, S�tv(cPs <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y N) METHOD ,.y j2"ceA AMOUNT USED <br /> . P L.E.L. READING AT REMOVAL (MUST BE < 20%) -,V'4 <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL((STEEL, IBERGLASS, OTHER) TANK SIZE QDd <br /> K C <br /> / 0 TANK CONDITIO (GOOD, OOR, HOLES) ,UO- 's,6� �,1es <br /> P N <br /> I S PIPE MATERIA (STEEL FIBERGLASS, OTHER) # FEET ,4 ,/ "' <br /> P T <br /> I PIPING CONDITION ((GOOD POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T , <br /> F A r4 <br /> I N 0 1 c S <br /> E K <br /> L <br /> D EXCAVATION SIZE: X ` X YDS OF SOIL: <br /> s- <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I <br /> P L P <br /> E z E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> z <br /> 0 H DEPTH TO G.W. : FTSAMPLING METHOD <br /> N 2 - T <br /> 0 # OF HOURS SINCE DEWATERING: <br /> aOTHER SAMPLE: <br /> LABORATORY: ��( c� b S SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />