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SJLHD - UNDERGROUND 'TANK CLOSURE/ALi.ANDONMEN'T INSYEC-1'lUN <br />(SHADED AREA TO BE FILLED 1N Pon THE FIRST TANK ONLY) <br />IG OWNER NAME <br />N CONTRACTOR <br />R SJLHD PERMIT M <br />L ..., <br />T <br />A <br />K <br />'I <br />P <br />I <br />N <br />C <br />I <br />E <br />L <br />D <br />I <br />�N <br />S <br />P <br />E <br />C <br />T <br />I <br />0. <br />N <br />..: <br />ISX <br />OWNER PHONE I <br />CON. PHONE 1 •o,, lr" , <br />/QS-- - 9/��v <br />EPA N FIRE PERMIT I <br />:►vita. lh 1'LAI:L•'---'jEFjPO[ili�����iiJaflufZJ:rrrr�nn�:6:aYiF <br />INSPECTOR �, �DATE, TANK M 39 <br />R RINSED Y N) METHOD <br />I �r� �e RINSE AMOUNTS <br />N RINSATE DISPOSAL SITE <br />S ��� SPidic Es <br />E MANIFEST M -OR- OTHER <br />V VAPORS PURGED (Y/N) METHOD AMOUNT USED <br />.A <br />•P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br />0 <br />R COMMENTS <br />C TANK MATERIAL (STEEL FIBERGLASS, OTHER) <br />0 TANK CONDITION (GOOD, POOR, HOLES) <br />N utilotvw <br />S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) <br />T <br />PIPING CONDITION (GOOD, POOR, HOLES)tfi4kw <br />DEPTH SOIL TYPE OBSERVATION <br />A ti <br />N <br />K <br />EXCAVATION SIZE* <br />__ X X YD <br />ADEPTH SOIL TYPE OBSERVATION <br />M P <br />P I <br />L P <br />I E <br />N <br />G TRqNCH DIMENSION ____ X __ X YDS OF SOIL <br />H DEPTH TO C.N.: FT SAMPLING METHOD <br />2 <br />0 N OF HOURS SINCE DEWATERING: <br />0 OTHER SAMPLE: <br />LABORATORY: SAMPLERS NAME: <br />CLOSURE IN PLACE MIXTURE:, VOLUME: <br />TANK SIZE <br />—� <br />w FEET <br />SAMPLE Q <br />Lab c..e.P.r ss� <br />,v c 3A <br />S OF SOIL: <br />SAMPLE p <br />