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SJLHD — UNDEI tOUND YANK CLOSURE/AILANDU S , ; / O <br /> (SHADED AREA—To DE FILLED IN FON T!!E FIRSTITANKiONLY)� <br /> � t • <br /> Git' OWNER 'NAME �5 <br /> E p�fdd C OWNER PHONE 1 G <br /> E 1,` <br /> CONTRACTOR��G�L_ ON. PHONEM —o �2 <br /> 70h fi�vice 24 6 — 333 <br /> R ' SJLHD PERMIT / A -�� <br /> L177'�ya 3 FIRE PERMIT 9 l <br /> INSPECTOR DATE <br /> TANK 1 39 — S ,f_ <br /> R RINSED <br /> I _ METHOD <br /> N RINSATE DISPOSAL SITE RINSE AMOUNT <br /> E MANIFEST 1 - <br /> -OR— OTHER <br /> V VAPORS PURGED (Y/N) <br /> .A HETHOD� _ AMOUNT USED c <br /> P L.E.L. READING AT REMOVAL (MUST 9E ( 2p,) /J <br /> O <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL ( TEEL FIBERGLASS, OTHER) TANK SIZE <br /> K C — <br /> / 0 TANK CONDITION (C00 , POOR, HOLES] ipi.✓ /t <br /> P N <br /> I S PIPE MATERIALSTEEL, FIBERGLASS, OTHER) 1 FEET <br /> P T <br /> I PIPING CONDITIO (GOOD,iPOOR, HOLES) <br /> N j <br /> G DEPTH, SOIL TYPE OBSERVATION <br /> T S MPLE 1 <br /> F A r <br /> I N <br /> E K <br /> L <br /> D 3; EXCAVATION SIZE: X I A G�7 <br /> N M P DEPTH SOIL TYPE OBSERVATION YDS OF SOIL: <br /> S P I SAMPLE 1 <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION __ X <br /> I __ X <br /> YDS OF SOIL <br /> 0 H DEPTH TO C.M. : <br /> N 2 FT SAMPLING METHOD <br /> 0 1 OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: J"T" SAMPLERS NAME: <br /> IN PLACE MIXTURE: Alt- <br /> CLOSURE <br /> VOLUME: <br /> ]:IfL;j 0�:i(7/$H) DRAM SITE MAP ON REVERSE <br />