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SJLHD - UNDE'GROUND TANK CLOSURE/AI{ANDOV" L•'NT INSPL•'CTIUN <br /> (SHADED AR, TO BE FILLED IN FOR THE F T TANK ONLY) <br /> -111-917 It <br /> Tc/P c.>.>,rnNnicc>Jic <br /> E IT <br /> OWNER NAME �"l OWNER PHONE N 9 / <br /> /7 i i ,s C an <br /> 62 0 9 5 - Y/ 7 <br /> N CONTRACTOR CON. PHONE# <br /> R ? SJ D PERMIT N c1 N!'0175- <br /> EPA M FIRE PERMIT N Fj 9_UDoZ ; <br /> Ly - <br /> INSPECTOR (!hog / DATE a <br /> //unf C - TANK 1 39 - <br /> R <br /> 9 -R RINSED (Y/N) METHOD <br /> I RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST N -OR- OTHER <br /> V VAPORS PURGED (Y/,N) METHOD /), y /c 2 AMOUNT USED <br /> A /S/6_s <br /> P L.E.L. READING AT REMOVAL (MUST BE C 20%) <br /> O <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLAS <br /> K C S, `OTHER) TANK SIZES ej <br /> / O TANK CONDITION GOOD POOR, HOLES) <br /> p N <br /> „I S PIPE MATERIAL STEEL FIBERGLASS, OTHER) N FEET <br /> P T <br /> I PIPING CONDITION -GOOD, POOR, HOLES) <br /> N <br /> G T DEPTH SOIL TYPE OBSERVATION SAMPLE N <br /> I N <br /> E K <br /> L <br /> D <br /> S: EXCAVATION SIZE: �aX Al'X 2] YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M p SAMPLE N <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X <br /> I YDS OF SOIL <br /> O H DEPTH TO C.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 N OF HOURS SINCE DEWATERING: <br /> r07 OTHER SAMPLE: <br /> LABORATORY: C' GSAMPLERS NAME S-oe <br /> nC3 �7i , <br /> CLOSURE IN PLACE MIXTURE:. VOLUME: <br /> !?II 23 043(7/88) DRAW SITE HAP ON REVERSE <br />