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SJLiIU UNDERGROUND TANK CLOSURE/ABANDONMENT INSPECTION <br /> (SHADED ARO TO BE FILLED IN FOR THE S <br /> T TANK ONLY) <br /> G [ OWNER NAME OWNER PHONE # <br /> E <br /> N < CONTRACTOR CON. PHONE# <br /> E <br /> R SJLHD PERMIT # EPA # FIRE PERMIT# <br /> A <br /> L <br /> INSPECTOR+< DATE �� �� TANK # 39 <br /> R RINSED, (YIN) METHOD � � i1 RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # S S(,>C -OR- OTHER <br /> V VAPORS PURGED METHOD L)Ll. / AMOUNT USED <2e;-- J <br /> A v <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) — <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FiELt2GLASS, OTHER ) TANK SIZE <br /> J�c-a)C'rlti i.._ <br /> K C <br /> / 0 TANK CONDITION aGOOD, 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 <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A — <br /> E K <br /> l <br /> D EXCAVATION SIZE: L X X �� YDS OF SOIL : a� s l <br /> S- <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <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 /> Fol OTHER SAMPLE: <br /> LABORATORY: / r , SAMPLERS NAME: <br /> c <br /> CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> DRAY SITE HAP ON REVERSE <br />