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SJLHD UNDERGROUND TANK CLOSURE/ABANDONMENT INSPECTION <br /> (SHADED AR TO BE FILLED IN FOR THE Fj T TANK ONLY) <br /> G < OWNER NAME OWNER PHONE # <br /> E <br /> N CONTRACTOR PHONE# <br /> E _ <br /> R < SJLHD PERMIT # EPA # FIRE PEM7T 4k� <br /> A - <br /> L <br /> INSPECTOR' C L DATE TANK # 39 - <br /> R RINSED (YJN) METHOD ��j � }� RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE i9 q <br /> E MANIFEST # S.�Gd -OR- OTHER <br /> V VAPORS PURGED %N) METHOD ({ AMOUNT USED ,4 -jL-) <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) _- <br /> 0 <br /> T R COMMENTS <br /> An rl5r� ae <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION POOR, HOLES ) rz-"� <br /> P N <br /> I S PIPE MATERIAL ( EELI) 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 /> I N <br /> E K 1 2 nC <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 911 T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> 0 H DEPTH TO G.W. : t'4loFT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: <br /> LABORATORY: n � ( 1 ( SAMPLERS NAME: —_ <br /> �,�'- �i: <br /> CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />