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SJLHD - UNDERGROUND 'TANK CLOSURE/Al(ANDONML••NT 1NSPJ:IC'1.1UN <br />(SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br />• i rsti„ �CYi [ <br />fS /fes �Cic c �p <br />O OWNER NAME OWNER PHONE 1 <br />yif-L 7G-/9iy <br />ECONTRACTOR CON. PNONEI' 'y�B"ssr/i <br />9lG - <br />R SJLH PERMIT <br />EPA 1 �n,a. i <br />A�LL� FIRE PERMIT N <br />INSPECTOR c4, pZ_- DATE S-3v 9D TANK 1 39 <br />R RINSED (Y/N) METHOD <br />I RINSE AMOUNT <br />N RINSATE DISPOSAL SITE - =s-y fF � o4 I <br />3 /610 w . /G -S L o-9 Br , 4 CA. <br />E HANIFSK' 1 -OR- OTHER <br />V VAPORS PURGED (Y/N) METHOD /D, <br />A Y' f of AMOUNT USED <br />•P L.E.L. READING AT REMOVAL (MUST BE < 20t)//} <br />O <br />T R COMMENTS <br />A <br />N TANK MATERIAL (STEE i FIBERGLASS, OTHER) TANK SIZE <br />K C <br />/ O TANK CONDITION OOD POnR. HOLES) <br />P N <br />I S PIPE N)1TERI)►I. irBL, FIBE SS, nT)(ER) 4 FEET <br />P T z <br />I PIPING CONDITIO - <br />N OOp, POOR, HOLES) <br />G DEPTH SOIL TYPE OBSERVATIO <br />T ks_qO SAMPLE Y <br />F A <br />N <br />L ' <br />D EXCAVATION SIZE! X /�' <br />YDS OF SOIL! <br />I A DEPTH SOIL TYPE OBSERVATION <br />N M P <br />S p SAMPLE M <br />I <br />P L P <br />E I <br />C N <br />T G TRFNCN DIMENSION , X— X <br />I YDS OF SOIL Wj, <br />0 H DEPTH To G.N.: — <br />N 2 FT SAMPLING METHOD <br />0 1 OF HOURS SINCE DEWATERING: B� <br />O OTHER SAMPLE: <br />LABORATORY:N&�% <br />/L'; �i/c/ate., SAMPLERS NAME: (? k U <br />' s <br />CLOSURE IN PLACE HIXTUR!� <br />E: <br />_ VOLUME: <br />