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SJLHD — UNDF^GROUND TANK CLOSURE/AI(AN <br />(SHADED ARS TO DE FILLED IN FOR THE <br />T INSc'ECTION <br />TANK ONLY) <br />G OWNER NAME OWNER PHONE q <br />E <br />CON. PHONEI <br />N CONTRACTOR <br />E � J/ T/l/l/l = 1l �o �i .:3 <br />R < SJLHD PERMIT Y EPA FIRE PERMIT <br />L....;ACy <br />INSPECTOR, — ��/ L� DATE 3 „23 f2 TANK Y 39 - Z 7q <br />R RINSED (Y� METHOD I RINSE AMOUNT <br />• I <br />N RINSATE DISPOSAL SITE <br />S <br />E MANIFEST V -OR- OTHER <br />VVAPORS PURGED CX/N) METHOD bid S OL- <br />A <br />P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br />0 <br />T R COMMENTS <br />AMOUNT USED <br />N <br />TANK MATERIAL ( EEL, FIBERGLASS, OTHER) <br />TANK SIZE 7iese� <br />K <br />/ <br />C <br />0 <br />TANK CONDITION. POOR, HOLES) <br />P <br />N <br />I <br />S <br />PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) <br />Y FEET <br />P <br />T <br />I <br />PIPING CONDITION (GOOD, POOR, HOLES) <br />N <br />G <br />DEPTH <br />SOIL TYPE <br />OBSERVATION <br />SAMPLE Y <br />T <br />F <br />A <br />I <br />N <br />E <br />K <br />L <br />D <br />EXCAVATION SIZE: XX <br />/ <br />YDS OF SOIL: .-u S( C1S <br />S- <br />r <br />A <br />DEPTH <br />SOIL TYPE <br />OBSERVATION <br />SAMPLE M <br />N <br />M <br />P <br />S <br />P <br />I <br />P <br />L <br />P <br />E <br />I <br />E <br />C <br />T <br />N <br />G <br />TRENCH DIMENSION X 2zX =7 <br />YDS OF SOIL <br />I <br />0moDEPTH <br />TO G.W.: 9 �y- FT <br />SAMPLING METHOD <br />N <br />I OF HOURS SINCE DEWATERING: <br />❑O <br />OTHER SAMPLE: <br />LABORATORY: <br />SAMPLERS NAME: <br />CLOSURE IN PLACE <br />I MIXTURE: <br />VOLUME: <br />DRAW SITE MAP ON REVERSE <br />