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SJLHD - UNDO'^GROUND TANK CLOSURE/AI(AND( MENT INSL'ECPIUN C(j OL <br /> (SHADED AR,_„ TO DE FILLED IN FOR THE 1...RST TANK ONLY) � q <br /> ( = ( = =pit' <br /> CACT P , <br /> G a OWNER NAME OWNER PHONE Y <br /> E i CaI T av9-9�/N-S7/ <br /> N < CONTRACTOR CON. PHONEq <br /> E fro /roc. 9/ro q,) -7 78d <br /> R < SJLHD ERMIT Y EPA Y FIREPERMIT q <br /> Ll //;? t <br /> `; '� _ - <br /> CLOSUN <br /> INSPECTOR �, OZ DATE 101101n TANK Y 39 - 7 - <br /> I 3 RINSED Y N) METHOD rheSS/ic2 RINSE AMOUNT� jsb <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST Y -OR- OTHER <br /> V VAPORS PURGED (9N) METHOD 1jr�/ Ice AMOUNT USED <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) per/ aTa <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL STEEL FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (100 , POOR, HOLES) <br /> P N <br /> „I S PIPE MATERIAL STEE , FIBERGLASS, OTHER) q FEET 5— <br /> P T <br /> I PIPING CONDITION POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE q <br /> T � _ <br /> F A is of 5 <br /> I N N <br /> E K <br /> L <br /> D EXCAVATION SIZE: 3 X X /a' YDS OF SOIL: ;)oo y ds <br /> 3: <br /> I A RPTH SOIL TYPE SERVATION SAMPLE q <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 /> I <br /> 0 H EDEPTHO G.N. : FT SAMPLING METHODN20 URS SINCE DEWATERING: <br /> 07 OTHER SAMPLE: <br /> LABORATORY: i ute (rah SAMPLERS NAME /r1 an <br /> .. <br /> L3N0/ 56,, : G <br /> LI—CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> 111 2:1 01.X7/88) DRAW SITE. MAP ON REVERSE <br />