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SJLHD — UNDER '-OUND TANK CLOSURE/ABANDONM--'T INSPECTION i <br /> (SHADED AREAS BE FILLED IN FOR THE FI&,l TANK ONLY) <br /> C, ' All , C , <br /> G OWNER 4a all W E OWNER PHONE # <br /> mu' u' u' 'MY1 W' ' <br /> E A P/ Q <br /> N ; CONTRACTORS ,, CON. PHONE# <br /> E 4 1 < <br /> R ; SJLHD PERMIT # EPA # FIRE PERMIT <br /> A ; <br /> L <br /> INSPECTOR5�� ��Sc DATE TANK # 39 <br /> R RINSED (Y,) METHOD RINSE AMOUNT <br /> I <br /> 3 RINSATE DISPOSAL SITE <br /> E MANIFEST # —OR— OTHER <br /> V VAPORS PURGED Y N) METHOD <br /> ��1 AMOUNT USED <br /> P L.E.L. READING AT REMOVAL (MUST A < 20%) <br /> O <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL TEEL FIBERGLASS, OTHER) T TANK SIZE <br /> K C <br /> / Ilin <br /> O TANK CONDITION (GOOD, POOR, HOLES ) <br /> P N r� <br /> I S PIPE MATERIALSTEEL] FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, @*1 HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A <br /> E K 1� uc w e.0 <br /> L « 7 - <br /> D EXCAVATIO SIA : 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 G TRENCH DIMENSION X �— X _ YDS OF SOI L (,�7Gb 7 d-5 <br /> I <br /> O H DEPTH TO G.W. • -- FT SAMPLING METHOD {"/` `�`��" <br /> N 2 , ( / v l �1. <br /> 0 # OF HOURS SINCE DEWATERING:/V <br /> j 67 <br /> F–o-11 OTHER SAMPLE: ��� 1�tJ C�l� <br /> LABORATORY: f� ta1r SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />