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-_ <br />SJLHD — UN GROUND 'DANK CL.OaURE/A4AN MLNT INSPECTION <br />.•f SHADED A TO BE FILLED IN FOR THE RST TANK ONLY) <br />., .. <br />J <br />EOWNER 'NAME OWNER PHONE # c®tie <br />sORO <br />N CONTRACTOR <br />E 5�® a/ CON. PHONE#'--IS— <br />R : SJLHD PERMIT # EPA # FIRE PERMIT <br />A — : <br />L • • <br />INSPECTOR DATE TANK # 39— R% <br />R RINSED (Y N) METHOD54 RINSE AMOUNT <br />SS" <br />N RINSATE DISPOSAL SITE ®, <br />S <br />E MANIFEST # —OR— OTHER <br />V VAPORS PURGED (Y N) METHOD IIIIIIAMOUNT USED <br />A .'� ®i6s <br />• P L.E.L. READING AT REMOVA (MUST BE < 20%) <br />0 <br />T R COMMENTS <br />A <br />N TANK MATERIAL (STEEL, IBERGLASS, THER) TANK SIZE f <br />K C <br />/ 0 TANK CONDITION (GOOD POOR, HOLES) <br />P N <br />` I S PIPE MATERIA (STEE FIBERGLASS, OTHER) # FEET <br />P T <br />I PIPING CONDITIO (GOOD OOR, HOLES) <br />N <br />G DEPTH SOIL TYPE OBSERVATION <br />T SAMPLE # <br />F A we <br />I N _ Mots ®est o4e <br />®� - z 0d i <br />E K — csco ,w <br />L gel �s <br />D EXCAVATION SIZE: L 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 />_ I <br />0 H DEPTH TO G.W.: <br />N 2 FT SAMPLING METHOD <br />® # OF HOURS SINCE DEWATERING: <br />0 OTHER SAMPLE: <br />LABORATORY: (klojep SAMPLERS NAME <br />ark a. s <br />CLOSURE IN PLACE MIXTURE: VOLUME: <br />P t( 21 �„ ,,� �Si DRAW SITE MAP ON R`RVERSE <br />6 <br />