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SJLHD - UNDERGROUND TANK CLOSURE/AB,ANDONMENT INSPECTION �� 6tz- <br /> (SHADED AREF 'O BE FILLED IN FOR THE FI' T TANK ONLY) <br /> q s ' <br /> OWNER NAME <br /> ( <br /> OWNER PHONE # <br /> OW ,Z <br /> N s CONTRACTOR alVlt/Fie CON. PHONE# <br /> R < SJLHD PERMIT # EPA # r' PE MIT # �f QZ .3 <br /> A <br /> L — <br /> INSPECTOR DATE / `� �� TANK # 39 - 2 AI - <br /> R RINSED (Y/N) M THOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y/N) METHOD / AMOUNT USED N <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 201) <br /> O <br /> T R COMMENTS <br /> A r <br /> N TANK MATERIA (ST FI RGLASS OTHER ) TANK SI 'L ' 7 5z) <br /> / 0 TANK CONDITION (GOOD POOR HOL �l�NK pciT 6 <vC w <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 T DEPTF I SOIL TYPE OBSERVATION nSAMPLEF A <br /> I NE K <br /> D EXCAVATION SIZE: X A X 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. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: <br /> HHi LABORATORY: �1��. Q� SAMPLERS NAME: r f,r <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> Ell 23 043(7/88) <br />