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SJLHD - UNDERGROUND 'TANK CLOSURE/AUANDONMEN'T 1NSPECPIUN <br />(SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br />imlvIm"NIT-111 fit. <br />eI51 i1;74..slleG <br />G OWNER NAME OWNER PHONE 1 <br />E B, rev/ yis G7�-/9v <br />N CONTRACTOR <br />E CON. PHONEI' <br />R SJLHD PERMIT 1cam`""' �3 d <br />EPATF' FIRE PERMIT 1 <br />Is <br />"g rip <br />�y: <br />INSPECTOR Gni DATE =; -3v -qv TANK 1 39 - 17c $" - 03 <br />R RINSED/" N) METHOD RINSE AMOUNT v � <br />I 8 J /oao <br />N RINSATE DISPOSAL SITEGsr�s/y �0�, / <br />Sf, Got /3el � , CA X10 �� <br />E MANIFEST I -OR- OTHER <br />VVAPORS PURGED ((Y!N ) METHOD /"r� AMOUNT USED <br />•P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br />0 <br />T R COMMENTS <br />A <br />N TANK MATERIAL S EEL, FIBERGLASS, OTHER) TANK SIZE RV <br />K C S Oce 0 <br />/ 0 TANK CONDITION GOOD, POOR, HOLES) <br />P N <br />'IS PIPE MATERIAL FI SS, OTHER) Y FEET <br />P T <br />I PIPING CONDITION <br />N 0 POOR, HOLES) <br />G T DEPTH SOIL TYPE OBSERVATION >Gm iB bk�90 SAMPLE 4 <br />I N 73 s <br />E K <br />L <br />D EXCAVATION SIZE: X X YDS OF SOIL: <br />3: <br />I A DEPTH SOIL TYPE OBSERVATION <br />N N P SAMPLE 1 <br />S P I <br />P L P <br />E I E <br />C N <br />T GTRF�NCH DIMENSIO <br />I X X YDS OF SOIL <br />0 H DEPTH TO G.W.: <br />N 2 FT SAMPLING METHOD <br />0 1 OF HOURS SINCE DEWATERING: <br />aOTHER SAMPLE: <br />LABORATORY: <br />SAMPLERS NAME: 1 <br />c cre <br />CLOSURE IN PLACE MIXTURE <br />VOLUME: <br />.... .... .. -.DRAW <br />