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SJLHO 'UNDRRGROUND 'TANK CLO:;URE/A4ANV- M�:NT IN:;PECTlUN <br /> SHADED ALJ1 TO BE FILLED IN FOR THE RST TANK ONLY) <br /> 00 <br /> N ,EoN <br /> E OWNER NAME _ / OWNER PHONE <br /> Mfr/ <br /> N CONTRACTOR : <br /> E CON. PHONE N ' <br /> R i SJLHD PERMIT N <br /> A EPA FIRE PERMIT N �? <br /> INSPECTOR,f- DATE����� TANK N 39 — _ <br /> R RINSED Y <br /> METHOD' w5Q <br /> I RINSE AMOUNT�r <br /> N RINSATE DISPOSAL SITE <br /> S SE»+nc'1':S <br /> E MANIFRST N _ <br /> —OR— OTHER <br /> V VAPORS PURGED' N) METHOD -7 <br /> A AMOUNT USED <br /> 2� <br /> •P L.E.L. READING AT REMOVAL (MUST HE < 20 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL TEE FIBERGLASS, OTHER) TANK SIZE <br /> K C 5--f--d <br /> / O TANK CONDITIO (GOOD POOR, HOLES) <br /> P it <br /> I S PIPE MATERI (STEEL FIBERGLASS, OTHER) 1 FEET <br /> P T <br /> I PIPING CONDITIO (G00 POOR,' HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE N <br /> F <br /> I N 40 G , <br /> E K <br /> L <br /> D EXCAVATION SIZE: �' .k' X <br /> S-. X .Z YDS OF SOIL: 3 <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N H P SAMPLE N <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X <br /> I X YpS OF SOIL <br /> 0 H DEPTH TO G.i�l. <br /> N 2 FT SAMPLING METHOD <br /> O N OF HOURS SINCE DEVATERING: <br /> 0 OTHER SAMPLE: <br /> . LABORATORY: GL. SAMPLERS NAME: <br /> MtlrL. <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> Vii 24j 0-1"'y;/88) DRAW SITE MAP ON REVERSE <br />