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SJLHO - UNDERGRUUND TANK CLOSURE/AwkNDON ENT INSPECTION <br /> (SHADED AR TO BE FILLED IN FOR THE T TANK ONLY) <br /> 1 y <br /> / • Co.. A { <br /> G { OWNER, NAM OWNER PHONE <br /> E <br /> N ti CONTRACTOR-f;r Fa rd <br /> _�L I d, / CON. PHONE# <br /> E <br /> R SJLHD PERMIT # EPA I FIRE PERMIT <br /> A <br /> L <br /> I NSPECTOR-ri',54 ' DATE // gle TANK # 39 - - <br /> oz <br /> R RINSED (Y/N) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR-- OTHER <br /> V VAPORS PURGED (9N) METHOD b 64—' AMOUNT USED <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE t 20%) <br /> O <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL ( STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION GDO , POOR, HOLES ) <br /> P N <br /> I []S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P <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 " h Li 1240 L&NZ-14.1k. <br /> D EXCAVATION SIZE: j X � X YDS OF SOIL : -5- <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 <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> 0 H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> Fo-11 OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACEFXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> Y <br />