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SJLHD - UNDERGROUND STf, -,GE TANK CLOSURE/ABANDONME" INSPECTION CHECKLIST <br /> SITE NAME MIEr, �Q ' Ti f e SITE ADDRESS <br /> G OWNER NAME &.(jc 14aY,-fwo �,u OWNER PHONE <br /> E <br /> N CONTRACTOR WCp,,t h0 e CON. PHONE# <br /> E _T : <br /> R SJLHD INSPECTOR : A✓ Ca�^ �s DATE: (pI a / TANK # <br /> A <br /> L REMOVAL CLOSURE IN PLACE TEMPORARY CLOSURE <br /> SJLHD PERMIT # E.P .A. # <br /> R RINSED (Y/N) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED ( Y/N) • METHOD 16t AMOUNT USED l��b <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) Iva <br /> 0 <br /> T [__R_Jj COMMENTS P <br /> A <br /> N TANK MATERIAL 5 � f 3 rf PIPING MATERIAL se �� <br /> K C <br /> / 0 TANK CONDITION �j�.fP �• u S f- <br /> P N _e <br /> I S PIPING CONDITION <br /> P T <br /> I R COMMENTS : go. G�w�o w;..s •+ ,�,,k�d }t„ - �? <br /> N U <br /> 3 <br /> G .3 <br /> T , <br /> F <br /> I <br /> E SOIL GROUNDWATER OTHER <br /> L <br /> D DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> I S i-3 . <br /> N A S S -� f v d <br /> S M O G 3% " <br /> en- t ! <br /> P P I / ,c <br /> E L L <br /> LL <br /> C I EXCAVATION SIZE: ? YDS OF SOIL: 7 S <br /> T N <br /> I G DESCRIBE -PIPELINE SAMPLING: <br /> 0 <br /> N H --DEPTH TO G.W. : FT I DESCRIBE SAMPLING METHOD <br /> 2 <br /> 0 - # OF'-" SINCE DEWATERING: <br /> O OTHER SAMPLE:, <br /> LABORATORY: Ca nam SAMPLERS NAME: �a rr bay,d6on <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br />