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SJLHD - UN GROUND 'TANK CLOSURE/A4AND ENT INSYEC'TIUN <br />(SHADED AMW TO BE FILLED IN FOR THE IWST TANK ONLY) <br />---- -------- -------- <br />INSPECTOR DATE V 39 - I - — �4_x --- _"'_i�- <br />R RINSED (YIN) METHOD" YIr RINSE AMOUNT <br />I <br />N RINSATE DISPOSAL SITE <br />S <br />E MANIFEST I -OR- OTHER <br />OA V VAPORS PURGEDDYN) METHOD TC_gAMOUNT USED 15 t <br />P L.E.L. READING AT REMOVAL (MUST BE '< 20%) 0 <br />T R COMMENTS ON . r . t� ` <br />A « <br />N TANK MATERIAL STEEL FIBERGLASS, OTHER) TANK SIZE <br />K C <br />/ 0 TANK CONDITION (GOOD, OOR HOLES) <br />P N <br />I S PIPE MATERIAL((STEZE. FIBERGLASS, OTHER) FEET <br />P T <br />I PIPING CONDITION (GOOD, POOR, HOLES) <br />N <br />G T DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />F A Z v fit <br />I N%�r <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 I E <br />C N <br />T G TRENCH DIMENSION X X YDS OF SOIL <br />I <br />0 H DEPTH TO G.W.: FT SAMPLING METHOD <br />N 2 <br />0 1 OF HOURS SINCE DEWATERING: <br />O OTHER SAMPLE: <br />L-ABORATORY: a SAMPLERS NAME: <br />CLOSURE IN PLACE I MIXTURE: VOLUME: <br />DRAW SITE MAP ON REVERSE <br />OWNER NAME <br />OWNER PHONE, # <br />• •. <br />awtv- <br />CON. PHONE#' ; <br />q Z Q aq, <br />r PERMIT I. <br />y r <br />' . r <br />---- -------- -------- <br />INSPECTOR DATE V 39 - I - — �4_x --- _"'_i�- <br />R RINSED (YIN) METHOD" YIr RINSE AMOUNT <br />I <br />N RINSATE DISPOSAL SITE <br />S <br />E MANIFEST I -OR- OTHER <br />OA V VAPORS PURGEDDYN) METHOD TC_gAMOUNT USED 15 t <br />P L.E.L. READING AT REMOVAL (MUST BE '< 20%) 0 <br />T R COMMENTS ON . r . t� ` <br />A « <br />N TANK MATERIAL STEEL FIBERGLASS, OTHER) TANK SIZE <br />K C <br />/ 0 TANK CONDITION (GOOD, OOR HOLES) <br />P N <br />I S PIPE MATERIAL((STEZE. FIBERGLASS, OTHER) FEET <br />P T <br />I PIPING CONDITION (GOOD, POOR, HOLES) <br />N <br />G T DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />F A Z v fit <br />I N%�r <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 I E <br />C N <br />T G TRENCH DIMENSION X X YDS OF SOIL <br />I <br />0 H DEPTH TO G.W.: FT SAMPLING METHOD <br />N 2 <br />0 1 OF HOURS SINCE DEWATERING: <br />O OTHER SAMPLE: <br />L-ABORATORY: a SAMPLERS NAME: <br />CLOSURE IN PLACE I MIXTURE: VOLUME: <br />DRAW SITE MAP ON REVERSE <br />