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SJLHD - UNDERGROUND ST AGE TANK CLOS DQ T <br /> UREZABANDONMF " INSPECTION CHECKeLIST <br /> (SHADED AREA .'o BE FILLED IN FOR THE FIR,11' TANK ONLY) <br /> ::11. r <br /> "R fill, <br /> G OWNER NAME OWNER PHONE r2oj\q6( c f3 S6 <br /> E <br /> CONTRACTOR CON. PHONE#�j ,,5 ) y6 -L -jqjj <br /> N C( <br /> E <br /> .................... <br /> R SJLHD PERMIT # EPA I RE DEPT <br /> A :r"!:; H:.: : 'Ilk <br /> :lp'.P R <br /> L RAW So f I 910-14-M,• <br /> 14111-1 4:":r:. :1 <br /> ....................................... <br /> L SJLHD INSPECTOR TANK # 39 - /-3 - <br /> 4-- <br /> R RINSED (Y N) METHOD/L) RINSE AMOUN <br /> 1 14 . ...... Tljl.4 <br /> 1 . <br /> N RINSATE DISPOSAL SITE A.,1 <br /> RINSE <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED_((Y�>/ ) METHOD A <br /> A <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 <br /> K C I _A 6C)o <br /> 0 TANK CONDITION (GOOD, POOR, HOLES) S�IZS�Yy-F} <br /> P N <br /> I S PIPE MATERIAL (,b"TEE FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> T —xr <br /> F A 0 <br /> IN ...... ----------- <br /> E K <br /> L <br /> D EXCAVATION SIZE: 5'X Cl YDS OF SO <br /> S <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> NM P ---------------------- -------- <br /> S P I <br /> PL P .........---............... <br /> E I E <br /> C N <br /> T G TRENCH DIMENSIONS : --[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 /> uHF-oll OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> A,4 <br /> CLOSURE IN PLACE VOLUME <br /> DRAW SITE MAP ON REVERSE <br />