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sJLHu - UNDEkGRUUND TANK CLOSURE/AAANDONMENT INSPECTION <br /> (SHADED AR TO BE FILLED IN FOR THE F JT TANK ONLY) <br /> G OWNER NAME S / OWNER PHONE f'G Z17(� <br /> E / <br /> N < CONTRACTOR S CON. PHONE# <br /> SIA <br /> E ' <br /> R < SJLHD PERMIT # EPA # FIRE PERMIT # <br /> A <br /> L <br /> INSPECTOR// <br /> //'� DATE /LI/7/�j TANK # 39 - 1603 - <br /> R RINSED (Y/N) METHOD a/14, RINSE AMOUNT 41 <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED N) METHODfin. AMOUNT USED <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 208) ,:; <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL ( STEEL', FIBERGLASS, OTHER) TANK SIZE ,np tt <br /> K C J t�C <br /> / 0 TANK CONDITION (GOOD,iPOOR, HOLES) <br /> P N <br /> I S PIPE MATERIAL J'STE , FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOP,� POOR, HOLES ) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: 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 GTRENCH DIMENSION X X YDS OF SOIL <br /> I — <br /> 0 mo <br /> DEPTH TO G.W. : FT SAMPLING METHOD <br /> N # OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: <br /> LABORATORY: �( q�1i< SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: V)LUME: <br /> DRAW SITE MAP ON REVERSE <br />