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SJLHD - UNDERGROUND 'TANK CLOSURE/AlIANDONMENT IN:wL•'G'1'IUN <br />(SHADED AREA TO DE FILLED IN FOR TILE FIRST TANK ONLY) <br />j1�lYlf"(]"it"�"lYl���`�����'iv�vR/•J:l:l •JJ:lLJ��•.._. �._. _. _._ <br />E , a OWNER NAME � Nl r/ v <br />OWNER PHONE 1 _ <br />N CONTRACT <br />E R rZiLl At M1_T�R S-F12V16- CON. PHONEM' �2O ,�; <br />R SJLHD PERMIT 1 2-Z <br />gr c <br />ObY% F & <br />L AIRE PER <br />n if <br />INSPECTOR, DATE TANK 1 39 <br />DATE/ Z ' <br />R RINSED Y/N) METHOD' <br />RINSE AMOUNT<i <br />N RINSATE DISPOSAL SITE <br />S V/� S <br />E MANIFEST 1 <br />-OR- OTHER <br />V VAPORS PURGED Y%N) METHOD <br />A �� ,-CP AMOUNT USED <br />P <br />O L.E.L. READING AT REMOVAL (MUST BE C 20%) <br />T R COMMENTS <br />A <br />N TANK MATERIAL STEEL, FIBERGLASS, <br />K C OTHER) TANK SIZE <br />/ 0 TANK CONDITION GOOD POOR, HOLES) <br />P N �� 72 �A►1 (<S <br />` I S PIPE MATERIALSTEEL FIBERGLASS, OTHER) 1 FEE I <br />I PIPING CONDITION (GOOD POOR, HOLES) /✓ �(� <br />N <br />G DEPTH SOIL TYPE OBSERVATION <br />T SAMP E 1 <br />F A 6 o aR <br />I N f o i u /o/Zq lib 5 <br />E K <br />L <br />D EXCAVATION SIZE: <br />3; X ,l X YDS OF SOIL: � ds <br />I A DEPTH SOIL TYPE OBSERVATION <br />N M P <br />S p SAMPLE 1 <br />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.N.: <br />N 2 FT SAMPLING METHOD <br />0 / OF HOURS SINCE DEWATERING: <br />7 OTHER SAMPLE: <br />LABORATORY: CAL Uj,q <br />TRIC' SAMPLERS NAME.- <br />CLOSURE <br />AME:CLOSURE IN PLACE MIXTURE: <br />VOLUME: <br />•,,. .. .. _ DRAW crmn .', , - <br />