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SJLHD - UNDERGROUND TANK CLOSURE/ABANDONMENT INSPECTION <br /> (SHADED AREA I BE FILLED IN FOR THE FIP " TANK ONLY) <br /> nun" lis <br /> lJ <br /> G O R NAME r //,. i�/ OWNER PHONE <br /> E z !7 /J <br /> N < CONTRACTOR CON. PHONE# S <br /> E <br /> R SJLHD PERMIT # �✓ A EPA # �/� FIRE PERMIT <br /> A <br /> L <br /> INSPECTOR DATEej-) TANK # 39 - <br /> R RINSED (Y N METHOD / RINSE AMOUNT <br /> 3 RINSATE DISPOSAL SITE �1 <br /> ^ !l/ <br /> E MANIFEST # -OR- OTHER J <br /> VA VAPORS PURGED ( / ) METHOD "D AM S <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) A <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIALTE , FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD, O HOLES) <br /> P N <br /> I S PIPE MATERIAL TEE , FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, 00 , HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T y <br /> F A <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: X 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 /> O H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />