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SJLHD — UN RGROUND TANK CLOSURE/AT�1'`51C'�`�.MLNT INSPECTION <br /> a (SHADE' lh A TO BE FILLED IN FOR ,1 iRST TANK ICONLX) <br /> IHIM 11 <br /> a � <br /> 1C. <br /> G i OWNER NAMES�Igt� dl�. CO. OWNER PHONE # ?' <br /> E , .? <br /> N CONTRACTOR VUl t-3>�S E CON. PHONE# ' <br /> E <br /> R ' s SJLHD PERMIT # _c, EPA -J FIRE PERMIT # <br /> INSPECTOR, DATEti�fz�>�gg TANK Y 39 <br /> R RINSED Y N) METHOD ti,-�5� RINSE AMOUNT Ur� nown <br /> - I <br /> N RINSATE DISPOSAL SITE �i <br /> E MANIFEST # -OR- : OTHER <br /> V :VAPORS PURGED4!!�f/N). METHOD � l - AMOUNT USED14 <br /> l <br /> P L.E.L. READING AT REMOVAL ,j(MUST BE < 20%)<---- u <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIA STEEL, FIBERGLASS, OTHER) TANK SIZE': o' <br /> K C i <br /> / 0 TANK CONDITIO (GO , POOR, HOLES) ', . <br /> P N <br /> I S -PIPE MATERIAL , FIBERGLASS, OTHER) # FEET ' <br /> P T � x <br /> I PIPING CONDITION (GOOD POO ) 0�0� 4" .V(S� <br /> N fi F <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> AF 1-3 (,LAI/ i r•Ia-j <br /> I N <br /> E K G p r. ) <br /> L L <br /> D EXCAVATION SIZE: 7C , 2 X YDS OF SOIL:. <br /> s- <br /> I A DEPTH SOIL TYPE OBSERVATION 3 SAMPLE '# <br /> N M P <br /> S P I1-3 CLrA <br /> 3-4C( i: S --tO '� L <br /> P L P � <br /> C N <br /> T G TRENCH DIMENSION iX X YDS OF SOIL y' <br /> ' O H DEPTH TO G.W. : SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWAT,ERI NG: <br /> OTHER SAMPLE: r� <br /> LABORATORY: >e lf�- �j-i✓r�tn �aa� SAMPLERS NAME: <br /> i tF <br /> CLOSURE IN PLACE MIXTURE: / VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> Eli 2:1 043(7/88) <br />