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S.ILHD - UNDERGROUND TANK CLOSURE/A$ANDONMENT INSPECTION <br /> (SHADED AREA 7 BE FILLED IN FOR THE FIR - TANK ONLY) <br /> G + OWNER NAME /�fLrnej%n Ct�f�� y`a OWNER PHONE <br /> E � <br /> N ; CONTRACTORS (�Ji�„gNiso f CON. PHONE# 7a 3 <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # /vsra[ <br /> A . . <br /> L <br /> INSPECTOR45eL. f DATE �?�G_s���t TANK # 39 - <br /> R RINSED (Y ) METHOD RINSE AMOUNT <br /> I <br /> S RINSATE DISPOSAL SITE <br /> E MANIFEST # -OR- OTHER <br /> VY N)VAPORS PURGED METHOD�� �C� AMOUNT USED <br /> A S <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FI ERGLASS, OTHER) TANK SIZE /1) DLk� �CCJ� <br /> K C <br /> / O TANK CONDITION GOO OLES ) No �'�"� c�s of H�ccs, urc� <br /> P N CoK oskf - i P OF K <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES ) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> ti rD DDtizo ccr� nox » <br /> F A jloop Discccc o .l G #/ <br /> I N <br /> � #ojQ. <br /> E K <br /> L <br /> D EXCAVATION SIZE: X X YDS OF SOIL : <br /> S _ <br /> I A DEPOIL TYPE OBSERVATI AMPLE # <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 YD OF SOIL <br /> I <br /> 0 H DEPTH TO G.W. r°��r2sk FT SAMPLING METHOD <br /> N <br /> 0 # OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: <br /> LABORATORY: aJfEGc7� SAMPLERS NAME: <br /> CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />