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SJLHD — UNDERGROUND ST - AGE TANK CLOSURE/ ABANDONMF7 INSPEC'T'ION CHECKLIST
<br /> ( SHADED AREA .'0 BE FILLED IN FOR THE FIR ., f TANK ONLY ) '
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<br /> G OWNER NAME OWNER PHONE
<br /> EGGSR ' 4 SOJLHDAPER # EPA J ::ON . PHONE #� F4 oct ) ..
<br /> L�/Y __........_..._ _......_._..._........ ..._..
<br /> { # /i¢ FIRE DEPT '— i
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<br /> _._ _ _ _._ .p _ . . .. _ , _ . _
<br /> SJLHD INSPECTOR �� (J TANK If 39
<br /> R RINSED ( Y ( ) METHOD A) /4 ^- -��RINSE AMOUNT�� - -
<br /> N RINSATE DISPOSAL SITE
<br /> S OR.- OTHER . ....... ....................._.. ..._........._..................
<br /> -
<br /> E MANIFEST # -
<br /> Aj
<br /> LA
<br /> V VAPORS PURGEDY7 ) METHOD W�/ n'7
<br /> A ..._ ................. .....
<br /> _.. ._.._.___._..._.
<br /> P L . E . L . READING AT REMOVAL ( MUST BE < 20 % ) /
<br /> O .._ .._._._...._.._.........__...__....._......_.._..-_................. ..........._.__._..........._....-
<br /> T R COMMENTS
<br /> N TANK MATERIAL STEEL FIBERGLASS , OTHER ) I TANK -SIZE
<br /> K C -
<br /> / 0 TANK CONDITION ( GOOD , POOR , HOLES )
<br /> PN - -.- -.. _ -- - __ . ....... .. . . . . . ..
<br /> I S PIPE MATERIAL ( TEE , FIBERGLASS , OTHER ) # FEET ;
<br /> . . . .. . . . .
<br /> P T _
<br /> NPIPING-CONDITION -( GOOD , - OOR - -HOLES ) - -
<br /> G DEPTH SOIL TYPE OBSERVATION^ SAMPLE #
<br /> T ......_ ... -r- ..,_ ......_..- - - - -_- -- __..._..._... . ._.._ ._ ..._._ ..
<br /> IN _- _ -_- _._._..__ .............,............._.._._...._.._........__..........._.__.._..._ .-._..........._,.. _.-_..._.. _ ._._.........._.
<br /> E K
<br /> L .....- - -.._. _._-..._....... .........__.._..,_._....._..... - -r . _ .. ... . ................................__ _ ...._...._._.. .. . __,.-....-..........
<br /> D EXCAVATION SIZE : �c"X b' x cl I -YDS OF
<br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE #
<br /> - 'v
<br /> S P I -'
<br /> i P L P - __.._ _ _-.. _ _ _ _ __- _. ......�_..._._- ......�- _....._.-_...
<br /> E I E - ._•• __ ___-
<br /> C N
<br /> T G TRENCH DIMENSIONS : YDS OF SOIL `�� - r�
<br /> I
<br /> 0 H DEPTH TO G . W . : FT SAMPLING METHOD
<br /> N 2 - - 5 .... --............
<br /> ... .. a'.�'�... ,..__......._..__.
<br /> 0 # OF HOURS SINCE DEWATERING :
<br /> OTHER SAMPLE : ...- • :•__-__I:_: :::.�,: _ .......
<br /> -+ I LALBORATORY : � � A SAMPLERS NAME- `AA -
<br /> CLLLLOOSURE IN PLACE MIXTURE : (T/ JJJ VOLUME :
<br /> DRAW SITE MAP ON REVERSE
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