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SJLHD - UNDI ;OUND 'TANK CLOSURWAIIANDL,,, NT INSL'Lt_lElUtf_ ,r / <br /> (S7IIADED A.R.Lw.—To BE FILLEDINFOR THR FIRST TANK ONLY) <br /> t �r �yit9c�1tK �dtildily� Xt,t. . r.�t. 7' a y' i d' �1 i <br /> E t+AliE — ADI (' tx �"lit � 1� cif �91 : <br /> G OWNER NAME OWNER PHONE Y <br /> E f,` CONTRACTOR h✓ �1 ��j CON. PHONEY • <br /> R SJLHD PERMIT Y EPA Y <br /> A yh FIRE PERMIT u <br /> L ` � � 7 ° <br /> INSPCCT R <br /> DATE iU,�_J � TANK Y 39 <br /> R RINSED (Y/N) METHOD <br /> I RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST Y -OR- OTHER <br /> V VAPORS PURGED (Y/,N) METHOD �� AMOUNT USED 17f <br /> A j <br /> P L.E.L. READING AT REMOVAL (MUST BE < 203) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K C �IFJQ <br /> / O TANK CONDITION <br /> P N GOOD POOR, HOLES) <br /> I S PIPE MATERIAL STEEL FIBERGLASS, OTHER) Y FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T U-� SAMPLE Y <br /> F A o <br /> I N c w ✓c <br /> E K <br /> L <br /> D EXCAVATION SIZE: X ' S X / <br /> g: .�_ � YDS OF SOIL: / , <br /> I A <br /> DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE Y <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION <br /> I _ X z I( 7 YDS OF SOIL <br /> 0 H DEPTH TO G.W. : <br /> N 2 2 t' FT SAMPLING METHOD <br /> 0 1 OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: : C t SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: <br /> --. VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />