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SJLHD - UNDERGROUND TANK CLOSURE/AUANDONMENT INSPECTION <br />(SHADED AREA To BE FILLED IN FOR THE FIRST TANK ONLY) <br />- tar�t�'�`�i'G1.%�'ii�G`f,7,�ttfilCaFit�lcaMKt:n.:.u:.,,,.._....-•-•-•-•---- <br />- �ersLiiiu S5c//-A66f(LS5"""" <br />G 21 <br />OWNER NAME " 1777 <br />E B, aPvi OWNER PHONE N yir_ U 7 yi y <br />N < CO(iTRAC 6Ri CON. PHONEN' <br />E <br />R SJLN PERMIT N EPAc M" te'''a' <br />A � �����;���� � �• � FIRE PERMIT N <br />INSPECTOR C�. Cz� DATE S"- 3�; q�, TANK 1 39- //,j 5-_ _ p/ <br />R RINSED JY/H) METHOD <br />RINSE AMOUNT <br />N RINSATE DISPOSAL SITE <br />S ' <br />E MANIFEST r <br />- - -OR- OTHER <br />V VAPORS PURGED (Y/N) NETIiOD, ;{N <br />A AMOUNT USED 7S/� <br />P L.E.L. READING AT REMOVAL (MUST BE < 20t) <br />0 <br />T R COMMENTS <br />A <br />N TANK MATERIAL STE FIBERGLASSj. OTHER) TANK SIZE <br />K C u� <br />/ 0 TANK CONDITION(00 <br />P N ♦ POOR, HOLES) <br />` <br />.,I S PIPE MATERIAL <br />P T TEEL FIBERGLASSo OTHER) 1 FEET <br />J <br />I PIPING CONDITION to 1) p00R� HOLES) ZO <br />N <br />G T DEPTH SOIL TYPE OBSERVATION rxi..yin k,, <br />F A SAMPLE N <br />/ � ; � •s -Yo <br />I N <br />E K <br />L <br />D EXCAVATION SIZE: <br />S' --- X -- X YDS OF SOIL: <br />I A DEPTH SOIL TYPE OBSERVATION <br />N M P SAMPLE r <br />S P I <br />P L p <br />E I E <br />C N <br />TDIMEG TRFNCH <br />NSION __ X <br />X YDS OF SOIL <br />OH DEPTH TO O.W.: <br />N 2 FT SAMPLING METHOD <br />0 1 OF HOURS SINCE DEWATERING: <br />0 OTHER SAMPLE: <br />LABORATORY: <br />SAMPLERS NAME:�,- <br />CLOSURE IN PLA CEMIXTURE:. <br />V/1L111A r- . <br />