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SJLHD - UNDROUND TANK CLOSURE/A$ANDO NT INSPECTION <br /> (SHADED AR TO BE FILLED IN FOR THE F*s'T TANK ONLY) <br /> CO cmc{ lltit r� "'S' 07 F W rpo ipi kiCn/ <br /> i <br /> G OWNER NAMEo (�c D 7L' IJ��S OWNER PHONE q 20 3(_�3 <br /> E -L <br /> N CONTRA TOR (UP4MO <�Pr CON. PHONEq 'Z _9v� '6 25Y <br /> E W Lbvo5 <br /> R < SJL PERMIT q EPA iiq` " i FIRE PERMIT q <br /> INSPECTOR C+ Q� DATE TANK 1 39 — 25r75' — Q� <br /> R RINSED (Y/ ) METHOD er r'�1' RI E"A`MOUwr - <br /> I (Ir&[e/ c_ Fi7, S r <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST I -OR- OTHER <br /> V VAPORS PURGE (, ) METHOD AMOUNT USED <br /> A i✓" <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20$) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAEQSTEEL FIBERGLASS, OTHER) TANK SIZE n-- � <br /> K C <br /> / 0 TANK CONDITION GOOD POOR, HOLES) <br /> P N <br /> I S PIPE MATERIALTEE , FIBERGLASS, OTHER) q FEET — !O <br /> P T <br /> I 1 PIPING CONDITION (GOOD P00 HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE q <br /> T _ <br /> F A a�isw/vi Ccu Gv <br /> I N 64 / 5 E <br /> E K <br /> L <br /> D EXCAVATION SIZE: X 35 X L YDS OF SOIL : <br /> 3: <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE q <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 q OF HOURS SINCE DEWATERING: <br /> OIL OTHER SAMPLE: <br /> LABORATORY <br /> : SAMPLERS z �U 1S i� (.r SAMPLERS NAME:u", s µ <br /> ` 7077 <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />