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SJLHD - UNDERGRUUND TANK CLOSURE/ABANDONMENT INSPECTION <br /> 7R (SHADED AF' � TO BE FILLED IN FOR THE �: T TANK ONLY) <br /> • 1� 4 trJ� l�" S h <br /> G OWNER .NAME K(C3 OWNER PHONE ' # <br /> E <br /> N CONTRACTOR.M r�U o� �'� CON. PHONE# . ��� c- ; <br /> S E � � .. <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # ^- [�. <br /> A <br /> INSPECTOR ,. :',DATE )ro TANK # 39 - <br /> R RINSED (Y =METHOD .�-� . TRINSE 'AMOUNT <br /> . I - <br /> N RINSATE DISPOSAL SITE '' <br /> S <br /> E MANIFEST # _ -OR- OTHER , <br /> V VAPORS PURGED ,(Y N) ' METHOD3��-fZ,/ f AMOUNT USED. ;..;'. <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20$) <br /> 0 _ <br /> T R COMMENTS <br /> A .. <br /> N TANK MATERIA (STEE FIBERGLAS HER) _' TANK `SIZEj GS : <br /> / 0 TANK CONDIT ON (GOOD, POOR, HOLES) <br /> P N <br /> I PIPE MATERIAL {STEEL=, FIBERGLASS, OTHER) I FEET -�--- <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T r <br /> F A � �. <br /> 14 1 <br /> I N , <br /> E r1c) k) .0y" orr2iol <br /> K . <br /> nctr ,-e o-� <br /> D EXCAVATION SIZE: X �' YDS OF SOIL: L1n&JcI� <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 O OIL <br /> I <br /> 0 H DEPTH TO G.W. : nonA_ SAMPLING METHOD J <br /> N 2 <br /> 0 I# OF HOURS SINCE DEWATERING: <br /> OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> .r <br />