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<br /> SJLHD — UNDERGROUNDlllST 3E TANK CLOSURE / ABANDONMP INSPECTION CHECKLIST
<br /> ( SHADED AREA .'0 BE FILLED IN FOR THE FIR .. P TANK ONLY )
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<br /> G OWNER NAME �/ � OWNER PHONE
<br /> E Z
<br /> O {�
<br /> - - --�.. ---�
<br /> N CONTRACTOR � _ CON . PHONE # ? ,9 ) q &6 L - 9010
<br /> R SJLHD PERMIT # EPA # �,///� FIR DEPT
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<br /> SJLHD INSPECTOR- TANK 39
<br /> 39_.. — --
<br /> R RINSED ( YN ) METHOD /f� RINSE AMOUNT t ' I�
<br /> I / --
<br /> N RINSATE DISPOSAL- SITE /L)
<br /> AJ
<br /> E MANIFEST # -- - — — — 0R — OTHER )
<br /> V VAPORS PURGED Y/ ) METHOD
<br /> A —�___..- Lr. _ ` -- ---
<br /> P L . E . L . READING AT REMOVAL ( MUST BE < 20 % ) /
<br /> 0 --- ..- --------- ---... ----- - aV — ---
<br /> T R COMMENTS
<br /> A
<br /> N TANK MATERIAL STEEL FIBERGLASS , OTHER ) TANK SIZE _
<br /> K C --- --- —
<br /> �1... H -- -moi o_
<br /> / 0 TANK CONDITION ( GOOD , POOR , HOLES )
<br /> PN _.. _ .._.._... —.-----_.. ... ..... _..__ . ..
<br />'r• I S PIPE MATERIAL ( TEE , FIBERGLASS , OTHER ) # FEET (/
<br /> P T -- -
<br /> j I PIPING CONDITION ( GOOD , OOR HOLES ) ( L�
<br />' N - - — — -
<br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE #
<br /> I N
<br /> E K
<br /> D EXCAVATION SIZE : Cy YDS OF SOIL : /2G
<br /> S
<br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE #
<br /> NM P --- --- - ._...._._.. -- - ._.............__.._ --
<br /> l S P I
<br /> i. P L P ----._.—...._..._......_.._... ...__---.._....._............................ ...
<br /> .............._—_.....-------
<br /> E I E —
<br /> CN ----- --
<br /> T G TRENCH DIMENSIONS : — YDS OF SOIL :
<br /> 0mo
<br /> DEPTH TO G . W . : �_ FT SAMPLING METHOD
<br /> N # OF HOURS SINCE DEWATERING :
<br /> E 0ll
<br /> OTHER SAMPLE :
<br /> I
<br /> LABORATORY : SAMPLERS NAME :
<br /> CLOSURE IN PLACE MIXTURE : AJ - VOLUME : —
<br /> DRAW SITE MAP ON REVERSE
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