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SJLHD - UNDERGP -"iND TANK CLOSURE/AB,ANDONMENT INSPECTION i <br /> (SHADED AREA BE FILLED IN FOR THE FIRS ANK ONLY) ' <br /> Y y I <br /> ' 1-Ml (?y OF LviJ E i�.i nG;Q/at_ - <br /> j Cl TY <br /> GOWNER NAME C`�. O►= L # <br /> Lo b r OWNER PHONE I <br /> E 70q� - 3' <br /> N CONTRACTOR ir'�u"� Com` �/ CON. PHONE# <br /> E ti <br /> R a SJLHD PERMIT # EPA # FIRE PERMIT # `'rJ NCO' ti <br /> 5 iTE <br /> A <br /> L <br /> INSPECTOR DATE G�I�CIJ TANK # 39 - - <br /> R RINSEDO METHOD t' �} �� i` i,� ,�- RINSE AMOUNT <br /> I i <br /> N RINSATE DISPOSALL SITE <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED Y/N) METHOD AMOUNT USED <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> O j <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL ( STEEL, FIBERGLASS, OTHER) FTANK SIZE �t�00 DrESC-L <br /> K C <br /> / 0 TANK CONDITION i(GOOD, ' POOR, HOLES ) rip HoLC%, �LiC��-iT C ��- <br /> P N " <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 , , } i� o <br /> F A ,1 � o C)� �;� yr c� *7 . <br /> I N , <br /> E K <br /> L - <br /> D EXCAVATION SIZE I� X .�= X , YDS OF SOIL: <br /> S = <br /> I A DEPT SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I <br /> P L P <br /> EI E <br /> C N <br /> T G TRENCH DIMENSION — X X YDS OF SOIL <br /> I <br /> O H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 1OTHER <br /> 0 SAMPLE: <br /> r-0 <br /> L-ABORATORY: SAMPLERS NAME: -- <br /> CLOSURE IN PLACE I MIXTURE: l VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> - I' <br />