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SJLNU - UNLER(;HUUND TANK CLOSURE/AB,ANDON14WNT INSPECTION <br /> (SHADED AREA. 0 BE FILLED IP-f FOR THE FI: TANK ONLY) <br /> �� . <br /> v <br /> G < OWNER NAME OWNER PHONE # <br /> E <br /> E CONTRACTOR CON. PHONE# 2a1 IZ( . <br /> R < SJLHD PERMIT # EPA # FIRE PERMIT # <br /> A <br /> L <br /> INSPECTOR DATE j/ Yi' TANK # 39 - - � <br /> R RINSED /N) METHOD,4&,�,),7 RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y/N) METHOD �r L AMOUNT USED -- <br /> A <br /> SED A �J <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20$) -- <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL STEE , FIBERGLASS, OTHER) TANK SIZE S' �l <br /> K C �" <br /> / 0 TANK CONDITION GOOD) <br /> OOD POOR, HOLES ) I'�fu^ N(Tc lcill),00 hoI s. ofdre <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 /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A rt Vw i 5 colo I <br /> I N 1 - cIo r c,t C '- * n <br /> E K <br /> L <br /> D EXCAVATION SIZE: 1i" X X 1 YDS OF SOIL: I �� <br /> S- <br /> I A `.DEPTH SOIL TYPE OBSERVATION MPLE # <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. : ' FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> aOTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: -- <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />