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SJLHU - uNbjehGRUONL 'TANK CLOSURE/ABANDONMENT INSPECTION <br /> (SHADED AREA T( E FILLED IN FOR THE FIRST 9NK ONLY) <br /> G OWNER NAME OWNER PHONE # <br /> E <br /> N CONTRACTOR CON. PHONE# <br /> E ' <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> A t <br /> L — <br /> INSPECTOR DATE /( N TANK # 39 <br /> R RINSED Y }N) METHOD5'lK(t/N1RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED ,(Y/N) METHOD - ��� AMOUNT USED <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE C 203) -- <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL 4STEEL, FIBERGLASS, OTHER) TANK SIZE . <br /> / O TANK CONDITION (GOOD, POOR, HOLES ) CO0. fd <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET - <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES ) ---- <br /> N <br /> _N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A I � _ ,C a <br /> �. <br /> I N G <br /> E K <br /> lcj <br /> L ) �( <br /> D EXCAVATION SIZE: X X YDS OF SOIL: O <br /> S- <br /> I A DEPTH SOIL TYPE OBSERVATION AMPLE # <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 OF SOIL <br /> I <br /> 0 H DEPTH TO G.W. i3tiv P�cro�nm,PT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: <br /> ulLABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: _-- VOLUME: <br /> DRAW SITE NAP ON REVERSE <br />