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SJLHO — UNL • UUNL TANK CLOSURE/A$ANDO NT INSPECTION <br /> (SHADED ARO BE FILLED IN FOR THE FIWT TANK ONLY) <br /> G OWNER NAMEOWNER PHONE # ,r <br /> E Free,-Y��r� 1 CA2 C/ 0 <br /> N CONTRACTOR �'� � �( CON. PHONE# (---2 C'q) c_/(r 4 <br /> E e <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> A e <br /> L <br /> INSPECTOR DATE _ TANK # 33 <br /> R RINSED (Y/N) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # —OR— OTHER <br /> jl <br /> V VAPORS PURGED (Y/N) METHOD AMOUNT USED— <br /> A I , T_ <br /> P L.E.L. READING AT REMOVAL (MUST BE C 20%) <br /> O <br /> T R11 COMMENTS <br /> A _ _ <br /> N TANK MATERIALTEEL, •`FIBERGLASS, OTHER) TANK SIZE , L <br /> K C <br /> / O TANK CONDITION (GOODPOOR, HOLES) <br /> P N <br /> I S PIPE MATERIAL STE44 FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION ,(GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A c nott' L� L(. o (" { <br /> > rG CCir� l 1 ! I l <br /> I N 0'0Lf M -SCO d r"� h <br /> E K <br /> L <br /> D EXCAVATION SIZE: _LL X IS X (_� YDS OF SOIL : f/ <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 /> Ell0 # OF HOURS SINCE DEWATERING: <br /> OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAB SITE MAP ON REVERSE <br />