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SJLHD - UNDIZGROUND TANK GLOSUkE/A4J1NDU MENT INSPECTION(SHADED ....AW TO BE FILLED IN FOR THE ST TANK ONLY) <br />G OWNER NAME ! + OWNER PHONE # j g '5_1 <br />E <br />N CONTRACTOR CON. PHONE # <br />E <br />R i SJLHD PERMIT # EPA # FIRE PERMIT # f ' _ o <br />Lp <br />A <br />L <br />INSPECTOR DATE TANK # 39 <br />R RINSED (Y/N) METHOD RINSE AMOUNTA <br />I <br />N RINSATE DISPOSAL SITE <br />S <br />E MANIFEST # -OR- OTHER <br />V VAPORS PURGED ( /N) METHOD r AMOUNT USED <br />A <br />P L.E.L. READING AT REMOVAL (MUST BEt< 20%) <br />0 <br />T R COMMENTS <br />A <br />N TANK MATERIAL STEEL FIBERGLASS, OTHER) TANK SIZE 1 <br />K C <br />/ 0 TANK CONDITION (GOOD, POOR HOLES) <br />P N <br />I S PIPE MATERIA (STEEL, IBERGLASS, OTHER)." # FEET <br />P T t, <br />I PIPING CONDITION (GOOD, POOR, HOLES) <br />N <br />G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />T <br />F A C"" <br />I N ) ®12 <br />E K - <br />L v ' �►• <br />D EXCAVATION SIZE: X'da 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 />z <br />0 H DEPTH TO G.W.: FT SAMPLING METHOD <br />N 2 <br />0 # OF HOURS SINCE DEWATERING: <br />O OTHER SAMPLE: <br />LABORATORY: t lar SAMPLERS, NAME: 61" Gr, <br />CLOSURE IN PLACE MIXTURE:. VOLUME: <br />Ell 23 041(7/88) DRAW SITE MAF ON REVERSE <br />