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SJLHD - UNDERGROUND TANK CLOSURE/ABANDONMENT INSPECTION <br /> (SHADED AREASP BE FILLED IN FOR THE FI TANK ONLY) <br /> )� A& 3N`i 7 r. v s ' h <br /> G OWNER NAME N°"k` OWNER PHONE # <br /> E c C . �� � Z i 4ZJb <br /> N t CONTRACTOR CON. PHONE# <br /> R < SJLHD PERMIT # EPA # FIRE PERMIT <br /> A 01115 1141RINII <br /> L Flow r <br /> INSPECTOR _AJ `A DATE 9_ -7_ - F TANK # 39 - ,4,ASc� - eco <br /> R RINSED YIN) METHOD 'Tpip�o RINSE AMOUNT <br /> I <br /> oc c psi w f}rR 1 �-1 'A'-( <br /> 3 Aj <br /> RINSATE DISPOSAL SITE <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y/N) METHOD AMOUNT USED ig IbS <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 STEELri FIBERGLASS, OTHER) TANK SIZE U Ou c <br /> K C ' <br /> / 0 TANK CONDITION (�OO, POOR, HOLES) <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N 1 11 <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T # <br /> F A <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: `I 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 /> 0moDEPTH TO G.W. : FT SAMPLING METHOD <br /> N <br /> # OF HOURS SINCE DEWATERING: <br /> FollOTHER SAMPLE: <br /> HiLABORATORY: (°w1� - 1� LSAMPLERS NAME: J ha �fiC2 <br /> CLOSURE IN PLACE T MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />