Laserfiche WebLink
SJLHD — UNDERGROUND 'TANK CLOSURE/AUANDOt MENT INSPECTIUN <br /> (SHADED } TO BE FILLED IN FOR T RST TANK ONLY) <br /> TR <br /> j -5 tS +h _ <br /> ra <br /> G OWNER NAME e) `J�.e tDar+. OWNER PHONE 1 <br /> E <br /> N i CONTRACTOR � �r, m, A_-V: CON. PHONE <br /> E 09 R�t�s Lo l <br /> R SJLHD PERMIT A EPA I FIRE PERMIT I� H*�0` o4 Trnc.a <br /> L Ori 'tp <br /> INSPECTOR C. LJCLCy,.w DATE , TANK 1 39 <br /> R RINSED (YIN) �, METHOD 'Frl' RINSE AMOUNT_5 w <br /> • I 10 tA <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST i -OR- OTHER <br /> V VAPORS PURGED i N) METHOD f C",� AMOUNT USED �5)b <br /> A <br /> P G.E.L. READING AT REMOVAL (MUST BE < 20%) ` a �o <br /> 0 <br /> T R COMMENTS ,Q tiSP <br /> A Gvn an olt•�- I r A c..� i r c cam,( rv.e..:t <br /> K C TANK MATERIAL STEEL FIBERGLASS, OTHER) TANK_ SIZE <br /> / 0 TANK CONDITION (GOOD, POOR HOLES) M ate <br /> P N 1 '� <br /> I S PIPE MATERIA (STEL, IBERGLASS, OTHER) :' Y FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) { <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION ,. SAMPLE <br /> T I <br /> F A n I <br /> I N 4$x •'1 Z <br /> E K — - <br /> L <br /> D EXCAVATION SIZE: , X X YDS., OF SOIL: <br /> S . <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE I)F <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 /> = O H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 1 OF ROURS' SINCE DEWATERING: , <br /> O OTHER SAMPLE:-- <br /> LABORATORY,; <br /> AMP,.LE:•LABORATORY; t SAMPLERS; NAME: � �� <br /> Cb G ca, <br /> CLOSURE IN PLACE MIXTURE:, VOLUME: <br /> DRAW SITE NAP ON REVERSE <br />