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SJLHD -• UNDgDGROUND TANK CLOSURE/A4ANDOMMENT INSPECTION <br /> (SHADED A TO BE FILLED IN FOR THE ., OST TANK ONLY) <br /> G OWNER NAMEC�h'� Y ^T� OWNER PHONE # } <br /> E Za 7 <br /> N r CONTRACTOR rN —T—CON. PHONE" <br /> E <br /> R t SJLHD PERMIT # EPA # FIRE PERMIT # <br /> L _ � � . � � <br /> INSPECTOR Gu�-�- DATE TANK # 39 - <br /> IRINSED (PN) METHOD 3C RINSE AMOUNT, <br /> N RINSATE DISPOSAL SITE <br /> S .vet•v <br /> E MANIFEST # -OR- OTHER <br /> AV VAPORS PURGED (Y N) METHOD AMOUNT USED <br /> . P L.E.L. READING AT REMOVAL (MUST BE C 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL STEEL FIBERGLASS, OTHER) TANK SIZE <br /> K C ASO <br /> / 0 TANK CONDITION (GOOD, POOR HOLES) <br /> P N <br /> I S PIPE MATERIAL ( STEEL FIBERGLASS, OTHER) # FEET �-- ' <br /> P T <br /> I PIPING CONDITION (GOOD POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A OftS ��iP ►5(� 0fz dN 4n dN <br /> I N <br /> E K <br /> L <br /> D s- <br /> EXCAVATION SIZE: X �' X j YDS OF SOIL: S <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 DEPTH TO G.W. : FT SAMPLING METHOD .1 <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> Fo-1 OTHER SAMPLE: <br /> ` LABORATORY: CGS 00-kr �a6S SAMPLERS NAME:l: - �ok <br /> Lc <br /> LOSURE IN PLACE I MIXTURE: L—VOLUME: <br /> Ell 23 013(7/88) DRAW SITE NAP ON REVERSE <br />