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SJLHD - UNDER ND TANK CLOSURI/A4ANDONMAW INSPECTIUN <br />(SHADED AREA BE FILLED IN FOR THE FII W TANK ONLY) <br />MEN T v <br />-C.1-Nc, <br />G OWNER NAME -r- OWNER PHONE <br />E 7 V <br />I <br />N CONTRACTOR e co N. PHONER 1�6 z' -r&h <br />EI <br />R SJLHD PERMIT I EPA I FIRE PERMIT 0 <br />.... .. ... M <br />A . .... . <br />Is M <br />T <br />A <br />N <br />K <br />P <br />I <br />P <br />I <br />N <br />G <br />F <br />I <br />E <br />L <br />D <br />I <br />N <br />S <br />P <br />E <br />C <br />T <br />I <br />0 <br />N <br />INSPECTORt <br />Aj 4A�W� I DATEfZ TANK 1 39 - <br />R RINSED L N) METHOD RINSE AMOUNT <br />I <br />N RINSATE DISPOSAL SITE <br />S <br />E MANIFEST I -OR- OTHER <br />A! I <br />V VAPORS PURGED g1N) METHOD I)AV. AMOUNT USED 1jeot <br />A <br />P L.E.L. READING AT REMOVAL (MUST B < 20%) <br />0 <br />R COMMENTS <br />TANK MATERIAL (S!!E <br />,, FIBERGLASS, OTHER) TANK SIZE <br />C <br />0 TANK CONDITION (GOOD <br />POOR, HOLES) <br />Js PIPE MATERIAL STEEL, FIBERGLASS, OTHER) I FEET <br />T PIPING CONDITION GOOD, POOR, HOLES) <br />DEPTH SOIL TYPE OBSERVATION SAMPLE I <br />T jj- <br />A O-AArIA(44 <br />N 1 7 <br />K <br />S- <br />A <br />M <br />P <br />L <br />I <br />N <br />G "I TRENCH DIMENSION — x — x I YDS OF SOIL <br />H DEPTH TO G.W.: FT SAMPLING METHOD <br />2 <br />0 1 OF HOURS SINCE DEWATERING: <br />70 1 OTHER SAMPLE: SAMPLERS NAME <br />LABORATORY: C4,av-h ti <br />CLOSURE IN PLACE MIXTURE: T VOLUME: <br />DRAW SITE MAP ON REVERSE <br />I <br />EXCAVATION SIZE: 15--x4��/ x 2-2-- 1 YDS OF SOIL: <br />DEPTH I SOIL TYPE I OBSERVATION I SAMPLE <br />Fit 2:1 043((/88) <br />A <br />