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SJLHD — UN' 2GROUND TANK CLOSURE/ALUINC MENT INSVECTIUN �iC r7 <br /> (SHADED Att'A TO BE FILLED IN FOR THE F'PRST TANK ONLY) <br /> Ifilml� . . , l = <br /> G OWNER NAME OWNER PHONE N <br /> g a 66 7 <br /> �wcQcP ����ra/C rloS- i <br /> E CONTRACTOR -Tlocr �� G -/ CON. PHONEN 1c c/�� <br /> ` ys8/ <br /> R ? SJLHD MIT NEPA N FIRE PERMIT N <br /> L . . . . . y <br /> ik <br /> INSPECTOR �! Z� DATE TANK N 39 - / /S- <br /> R <br /> SR RINSED YON) METHOD �v�/� ��r:✓� RINSE AMOUNT <br /> I f <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST N -OR- OTHER <br /> V VAPORS PURGED 0/N) METHOD �� « AMOUNT USED <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE C 20%) <br /> O <br /> T R COMMENTS <br /> A <br /> K C TANK MATERIAL STE , FIBERGLASS, OTHER) TANK SIZE 00 <br /> / 0 TANK CONDITION 4G' OuPO , HOLES) v <br /> P N ee�Ylrosi�sr Al <br /> I S PIPE 1111 11 ISTEEL FIBERGLASS, OTHER) N FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION Pbs ry j"'A SAMPLE N <br /> T _ <br /> F A /C�/i Si/� , _ SSS <br /> I N <br /> E K s ie w e e <br /> L <br /> D EXCAVATION SIZE: 35'�X /02 X /a YDS OF SOIL : <br /> 8- <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE N <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 _ 3 <br /> 0 H DEPTH TO G. FT SAMPLING METHOD <br /> N 2 �rtss / rhes <br /> 0 N OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: ` '`u a. GhS SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE VOLUME: <br /> 1 2:1 01:1(7/88) DRAW SITE MAP ON REVERSE <br />