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SJLHD - UNDERGROUND TANK CLOSURE/ABANDONMENT INSPECTION 1 <br /> (SHADED Ah& TO BE FILLED IN FOR THE JOST TANK ONLY) <br /> Em err c <br /> G OW R'NAME e 1 OWNER P NE # <br /> Ea 14 <br /> N < CONTI AAC OR CON. PHONE# C9/�) y&7 -d ay <br /> E <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> A <br /> L — <br /> INSPECTOR Tj,� eacGL DATE a TANK # 39 - / 270 <br /> R RINSED (Y ME H06 RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED 6�N) METH D AMOUNT SED <br /> A <br /> P L .E.L. READING AT REMOVAL (MUS BE < 20%) <br /> 0 <br /> T R COMMENTS /t)o 4,Ek, Yi Q d <br /> A <br /> N TANK MATERIAL (STEEL, (EIBERGLAS OTHER) TANK SIZEa w 4 <br /> K C <br /> / O TANK CONDITION GOOD POOR, HOLES ) <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGnLA +,S OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES ) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> I N { eCC ac 0 Sos+ /f <br /> -pr doilo o <br /> E K (' <br /> L N a v2 5 a.i.0 A) o O `s <br /> En <br /> D EXCAVATION SIZE: L X / X YDS OF SOIL: a <br /> S- <br /> I A DEPTH SOIL TYPE OBSERVATION SA LE # <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 /> OTHER SAMPLE: <br /> LABORATORY: (?Q,/;d�h! ((Ja der La 6 s SAMPLERS NAME: <br /> CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />