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SJLHD - UNDES20UND 'TANK CLOSURE/A1�AND0*1 <br /> 1' INSPECTION <br /> (SHADED ARE TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> l ara lel /YUM( <br /> G < OWNER NAME 0 _ OWNER PHONE N <br /> E <br /> N CONTRACTOR CON. PHONE# <br /> E <br /> R < SJLHD PERMIT NCEPA getl,COO`�?? ? FIRE PERMIT N <br /> INSPECTOR 0 , 61Z, I <br /> DATE ld_13_s`! TANK N 39 - <br /> R RINSED YON) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST N - /�crcccQ Vic' ltc�SUr -OR- OTHER <br /> V VAPORS PURGED &N) METHOD /�� AMOUNT USED D �� <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE ( 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIALSTEE , FIBERGLASS, OTHER) TANK SIZE ��620 c2,;;,L, <br /> K C <br /> / 0 TANK CONDITION GOOD', POOR, HOLES) <br /> P N <br /> ' I S PIPE MATERIAL STEEL, FIBERGLASS, OTHER) N FEET <br /> P T /O <br /> I PIPING CONDITION (GOOD, POOR, HOLES ) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE N <br /> T <br /> F A %L C/aa s. <s coo>a{Uw v E <br /> I N 11 <br /> E K <br /> L <br /> D EXCAVATION SIZE: _30 X / X // ` YDS OF SOIL : <br /> 3: <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE N <br /> N M P <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRNNCH DIMENSION X X YDS OF SOIL <br /> I <br /> 0 H DEPTH TO C.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 N OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: (�Gr/{ lc'cre z�'z SAMPLERS NAME: <br /> AJC(✓� <br /> CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERS!: <br /> !til 23 04:1(7/38) <br />