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SJLHD - UND! ';R(JUND 'TANK CLOS URL••/AIANI)( ENT INSL'L•G1' it <br /> (SHADED ARL-. TO DE FILED IN FOR THE FIRST TANK ONLY) S�6 <br /> + `JO/✓ VeN • i N Mp <br /> E ; + OWNE�j OWNER PHONE tl �°q- <G � 6 .72 <br /> '[- M � <br /> IE CONTRACTOR ffl CON. PHONEM ' C p f <br /> R < SJLHD PERMIT YE � / S/7 U <br /> �• yoyy• �� � �• FIRE PERMIT b <br /> L <br /> JKiK <br /> INSPECTOR DATES �9 TANK Y 39 <br /> R RINSEDMETHOD s" <br /> I �/f�/, RINSE AMOUNT -ZG! <br /> N RINSATE DISPOSAL SITE <br /> S <br /> Onl r°e Fi N e c/�S <br /> E MANIFRST I -OR- OTHER <br /> V VAPORS PURG11 N) METHOD <br /> A V -� �� AMOUNT USEDJS �9J_ <br /> P L.E.L. READING AT REMOVAL (MUST BE < 203) wf- <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITIONi,(GOOD <br /> P N POOR, HOLES) <br /> I S PIPE MATERIAL (STEELFIBERGLASS,,. THER) Y FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES)I /'l <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE Y <br /> F A <br /> I Nr7 Cd <br /> E K <br /> L <br /> D 2. <br /> EXCAVATION SIZE: v X 0 <br /> S; �. 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 <br /> I YDS OF SOIL <br /> 0 H DEPTH TO C.W. : FT SAMPLING METHOD <br /> N 2 <br /> O R OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: <br /> 1 LABORATORY: 6A N om(e, SAMPLERS NA E: <br /> � 7 <br /> CLOSURE IN PLACE MIXTURE. <br /> VOLUME: <br /> ]ill 2;J 0�;t(7/88) DRAW SITE MAP ON REVERSE <br /> • <br />