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SJLHO - UNDERGR6_JI) TANK CLOSURE/A4ANDONMENT INSPECTION <br /> (SHADED AR TO BE FILLED IN FOR THE T TANK ONLY) <br /> w %man <br /> igQ boot, <br /> f- <br /> G < OWNER AME OWNER PHONE # <br /> E <br /> N CONTRACTOR CON. PHONE# <br /> E <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # ti <br /> A <br /> L <br /> INSPECTOR -r I&S DATE ,IITANK # 39 - 9 - 0� <br /> R RINSED (Y40 METHO6 RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (9N) Em ETM C_� -0- AMOUNT USED <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST%E < 20%) r <br /> O <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL STEEL, FIBERGLASS, OTHER) FTANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES ) r a!;�e v i 5; We <br /> P N .rte ov Q.0 <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES ) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T }, lo.Ee `1 <br /> F A I cQ ria —S <br /> TT <br /> I N <br /> E K Lim& n <br /> L <br /> D EXCAVATION SIZE: J_�f X X YDS OF SOIL : <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 /> Q ' OTHER SAMPLE: <br /> ttt <br /> LABORATORY: /' � y � SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />