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SJLHD - UNDERGROUND 'TANK CLOSURE/A1tANDONML•'NT INSYI:CTIUN <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> rl�/i77 Gi7S Seer vc� �(" 4� hd SSC �I�aOh <br /> G c OWNER NAME <br /> E <br /> .Trr T����-+�. ..ns OWNER PHONE I <br /> N CONTRACTOR S'l co CON. PHONE# • <br /> E <br /> R 3JLll9 PERMIT 1 EPA 1 FIRE PERMIT 1 <br /> L _,�� 7 . . . . <br /> INSPECTOR 6 . 0v DATE 3 aG--tl TANK 1 39 - /Y7y - -� <br /> R RINSED /N) METHOD � ` - RINSE AMOUNT �Y�ssaP <br /> ' 1 <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E HANIMST M -OR- OTHER <br /> VVAPORS PURGED (�N) METHOD �` ��Y AMOUNT USED <br /> •P L.E.L. READING AT REMOVAL (MUST BE < 20%) G �� <br /> 0 <br /> T R COMMENTS ' <br /> A <br /> N TANK HATERIAL ( TEE , FIBERGLASS, OTHER) TANK SIZE <br /> K C $-pdv <br /> / 0 TANK CONDITION (GO D, OOR HOLES) <br /> ' P N <br /> I B PIPE MATERIAL (STEEL FIBERGLASS, OTHER) 1 FEET C <br /> �P T <br /> 1 PIPING CONDITION (GOOD, OOR HOLES) <br /> N <br /> G T DEPTH I SOILTYPE OBSERVATION SAMPLE 1 <br /> F AAf <br /> �d voror l <br /> I N `�'% � <br /> E K <br /> L <br /> D EXCAVATION SIZE: X L ' X YDS-OF SOIL: <br /> s: <br /> I A DEPTH SOIL TYPE OBSERVATI <br /> M P SAMPLE M <br /> �N <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRqNCH DINENSIOH X <br /> I __ X YDS OF SOIL <br /> 0 H DEPTH TO C.X. : FT SAMPLING METHOD <br /> N 2 <br /> 0 1 OF HOURS SINCE DEWATERING: <br /> O OTHER SAMPLE: , <br /> j —LABORATORY: A� ha GGA SAMPLERS NAME: CLi <br /> CLOSURE IN PLACE I MIXTURE: vnr.tiHr. . 1. <br />