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SJLHD - UNDERGROUND 'TANK CLOSURE/A4ANDONHL•'NT INSPECTION <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> PSI <br /> G < <br /> OWNER NAME PHONE 1 <br /> E OWNER q r 2�. �� <br /> N CONTRACTOR <br /> E ��� CON. PHONEI <br /> f R SJLHD PERMIT 1 EPA ICACaoo5'07W FIRE PERMIT 1 ` <br /> L �/- o <br /> INSPECTOR �7DATE y-a-yi TANK 1 39 <br /> I RINSED (ON) METHOD ��le RINSE AMOUNT, <br /> 3 RINSATE DISPOSAL SITE ��/ � &4-V <br /> E HANIFRST 1 -OR- OTHER <br /> V VAPORS PURGED fqH) METHOD _ AMOUNT USED <br /> •P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS ' <br /> A <br /> N TANK MATERIAL , FIBERGLASS, OTHER) TANK SIZE <br /> K C Cp <br /> / 0 TANK CONDITION (GOOD, OR HOLES) <br /> ' P N <br /> ` I 3 PIPE MATERIAL ( 1� FIBERGLASS OTHER) 1 FEET j <br /> P T <br /> I PIPING CONDITION (GOOD, , HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE 1 <br /> T <br /> F A <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: a//X YDS OF SOIL: <br /> 9; <br /> I A DEPTH SOIL TYPE OBSERVATION - AMPLE 1 <br /> N H P <br /> S p I <br /> P L P <br /> E I E <br /> C N <br /> T G TRF)NCH DIHENSIOI) .912LX X 3YDS OF SOIL <br /> I <br /> 0' H DEPTH TO G.N. : FT _ SAMPLING METHOD <br /> N 2 vuss f 6 <br /> 0 1 OF HOURS SINCE DEHATERING: <br /> 0 OTHER SAMPLE: <br /> LA80R6TORY: �oci.�o may LaAC SAMPLERS NAME: - <br /> CLOSURE IN PLACE HIXTURE*e IVOLUME: <br />