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SJLHD — UND: ;ROUND TANK CLOSUkL/ALiANDG�i:NT INSLIECTIUN <br /> (SHADED ARPX TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> f?iGr/a.c,�. v/Coni a JfoCk 4V_ � <br /> G OWNER NAME �t' Ga�O� OWNER PHONE p 7 7 77 <br /> E t` <br /> N CONTRACTOR , ,r�CC� CON. PHONEp <br /> E v cor (o3 <br /> R SJLH PERMIT p EPA I FIRE PERMIT p 1,2 ? 31 <br /> L : <br /> INSPECTOR lit oz. DATE /U`a3/� TANK 1 39 - /031 - (J <br /> R RINSED (Y ) METHOD h) ' V dgf2 RINSE AMOUNT,-0 <br /> I <br /> N RINSATE DISPOSAL SITE /)11/!J <br /> S <br /> E MANIFEST I -OR- OTHER <br /> V VAPORS PURGED Y ) METHOD �9`_ �e AMOUNT USED ` 6S <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A _ <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE / �0 <br /> K C <br /> / 0 TANK CONDITION GOOD POOR, HOLES) <br /> P N <br /> I S PIPE MATERIAL STEE , FIBERGLASS, OTHER) p FEET 0 <br /> P T <br /> I PIPING CONDITION (G D;- 90R,OR, HOLES ) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE Y <br /> T <br /> F A <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: /S X X 1_ YDS OF SOIL : _ 3 <br /> 3- <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE Y <br /> N M P <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 /> 0 H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 9 OF HOURS SINCE DEWATERING: <br /> 1 071 OTHER SAMPLE: <br /> LABORATORY: R t SAMPLERS NAME: <br /> Li Cn dh 1 c <br /> CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />