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SJLHD — UNDERGROUND TANK CLOSURE/ABANDONM T INSPECTION <br /> (SHADED AREA BE FILLED IN FOR THE FIIW TANK ONLY) <br /> G OWC�(E NAM OWNER PHONE # 94 � _ 9.3 <br /> E S� r <br /> N a CONT ACTOR {vCKF�vc. t�' CON. PHONE# b <br /> E <br /> FIRE PERMIT # 1 <br /> R < SJLHD PERMIT # EPA # �2 Y- <br /> A <br /> L — <br /> INSPECTOR7-/`� (�PCc DATE/b /3 S TANK # 39 - /01 �5 <br /> R RINSED (Y N)2 METHOD RINSE AMOUNT I <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED X/N) METH <br /> AMOUNT US <br /> A � <br /> P <br /> L.E.L. READING AT REMOVAL (MUS BE < 20%) <br /> 0 <br /> T R COMMENTS S do1 y � ih <br /> A <br /> FIBERGLASS, OTHER) ANK SI E <br /> N TANK MATERliL <br /> K C <br /> / 0 TANK CONDITION (GOOD, 00TOLES <br /> p N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET 7 <br /> p T <br /> I PIPING CONDITION (GOOD, POOR, HOLES ) G <br /> NSAMPLE # <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T <br /> F A <br /> E K <br /> D EXCAVATION SIZE: X X _� YDS OF SOIL: 9 � <br /> S SAMPLE # <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M p <br /> S P <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION �j XX -� YDS OF SOIL` _� ,S �3 <br /> I <br /> 0 H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> I O i OTHER SAMPLE: <br /> II�—LJJABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />