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SJLHD - UNDERGROUND TANK CLOSURE/ABANDONMENT INSPECTION <br /> (SHADED AREA 9 BE FILLED IN FOR THE FIR- - TANK ONLY) <br /> Iff <br /> 0 ry ' S v 5v rs <br /> G OWNER NAME D�1(1 mecos OWNER PHONE # <br /> E <br /> N CONTRACTOR S%Mcc) CON. PHONE# �o9 5 3 <br /> E ' <br /> R a SJLHD PERMIT # EPA # FIRE PERMIT # gg -0(33 <br /> A <br /> L — <br /> INSPECTOR 3 . I-Ad i I(A I <br /> DATE 6_I 1_�� TANK # 39 - - <br /> R RINSED �N) METHOD �r 1e 2i�5� RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED *N) METHOD TrAMOUNT USED <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 208) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIALS TEEL FIBERGLASS, OTHER) TAN S'fZE <br /> K C _� <br /> / 0 TANK CONDITION (GOOD, OOR, HOLES) 01Qdular YAC M Sro� Ic�yin o — <br /> P N — <br /> I S PIPE MATERIAL tdiEEL FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES ) ipe Shcy+ Q fi prior fa R2�w <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T p N p i4flo2 <br /> F A <br /> I N <br /> E K <br /> Lo <br /> D EXCAVATION SIZE: X 5 C `T ` YDS OF SOIL: <br /> S- <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <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. : VnIC FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> OTHER SAMPLE: <br /> LABORATORY: CAL 14;L0SAMPLERS NAME: �vhnl C-rricei <br /> H[� <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />