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SJLHO - UNUEI :OUNU 'TANK CLOSURi,/AIIANDON 'NT 1N�A ECTIUCl U <br /> (SHADED AREi—fO BE FILLED IN FOR THE FI�--.T TANK ONLY <br /> G OWNER NAME S F OW ER PHON 'yr <br /> E — �7�-6�uf•' <br /> N CONTRACTOR �� /j�V �� CON. PHONEY <br /> t s n� ,cas <br /> R < SJLHD PERMIT Y EPL �9P(yfy9y FIRE PERMIT Y <br /> Lc � � / <br /> INSPECTOR/,,,// DATE J!-/7_ TANK Y 39 - /U�b <br /> R RINSED #iMETHOD �� RINSE AMOUNT EM <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST Y -OR- OTHER <br /> V VAPORS PURGED (Y/ ) METHOD QFC AMOUNT USED <br /> A <br /> p L.E.L. READING AT REMOVAL (MUST BE C 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIA (STEEL, FIBERGLASS, OTHER) TANK SIZE SQ <br /> K C <br /> / O TANK CONDITION (GOOD POOR, HOLES ) <br /> p N <br /> I S PIPE MATERIAL (STEEL, IBERGLASS, OTHER) Y FEET <br /> p T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE Y <br /> T <br /> F A o rni <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: 3 X —.3— X YDS OF SOIL: / �T <br /> 3: <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE Y <br /> N M p <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 <br /> 0 H DEPTH TO C.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 Y OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: <br /> LABORATORY: T L SAMPLERS NAME:14Ijj iNr) <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> F.II 2:1 043(7/88) <br />