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SJLHD — UNDR "ROUND 'DANK CLO:aURE/ASND •NT INSPEC`YIUN <br />(.SHADED A TO BE FI LLED IN FOR TIDE : T TANK ONLY ) <br />��= <br />•1-11- , <br />G OWNER NAME OWNER PHONE # PSI 3 <br />N CONTRACTOR CON. PHONE#• <br />E aC_ s�rE�t'2000 <br />R SJLHD PERMIT # EPA # t FIRE PERMIT # <br />INSPECTOR C DATE I TANK # 39 <br />R RINSED (Y N) METHOD <br />I i� RINSE AMOUNT <br />Pair <br />N RINSATE DISPOSAL SITE <br />S <br />E MANIFEST # —OR— OTHER <br />V VAPORS PURGE (Y N) METHOD <br />A . ][`C AMOUNT USED � <br />P L.E.L. READING AT REMOVAL (MUST BE <20%) <br />O <br />T R COMMENTS <br />A <br />N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br />K C 000 <br />/ 0 TANK CONDITIO (GOOD POOR, HOLES) <br />P N _.. 'a <br />I S PIPE MATERIAL ST , FIBERGLASS, OTHER) # FEET.P%����' <br />P T <br />I PIPING CONDITION (GOOD, POOR, HOLES) <br />N <br />G DEPTH SOIL TYPE OBSERVATION <br />T SAMPLE # <br />F A A,,6 <br />I N <br />E K <br />L <br />D EXCAVATION SIZE:® 01 <br />S. X X YDS OF SOIL: <br />I A DEPTH SOIL TYPE OBSERVATION <br />N M P SAMPLE # <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 />z <br />0 H DEPTH TO G.W.: ° <br />N 2 �� covr,�� FT SAMPLING METHOD <br />a� �� <br />0 # OF HOURS SINCE DEWATERING. 0 <br />0 OTHER SAMPLE: <br />LABORATO11 R11 Y: SAMPLERS NAME;; <br />CLOSURE IN PLACE MIXTURE. VOLUME: <br />1,1► dpt G " `" �$$ DRAW SITE MAP ON REVERSE <br />