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SJLHD - UNDERGI,.JNO 'TANK CLOSURE/AIIANDONMk. INSYL•(CTIUN <br /> (SHADED AREA TO DE FILLEDIN FOR TUE FIRST TANK ONLY) <br /> ,Ulu wo . <br /> G OWNER NAME / / OWNER PHONE Y -2 y _ 3S X72 5 <br /> E <br /> N CONTRACTOR 1 F o _ � - ��1L CON. PHONEN ' �/�6_ %7_ 1 5 <br /> E <br /> RSJLHD PERMIT I EPA I FIRE PERMIT I <br /> L � � = <br /> INSPECTOR DATTANK Y 39 — O o — <br /> R RINSED (Y/N) METHOD 77 :>o RINSE AMOUNT <br /> o <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST M -OR- OTHER <br /> V VAPORS PURGED (Y ) METHOD Jif= 1 = '`' AMOUNT USED <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL STEEL,, FIBERGLASS, OTHER) TANK SIZE ,� <br /> K C <br /> / 0 TANK CONDITION GOOD POOR, HOLES) <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) Y FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G 0�( DEPTH SOIL TYPE OBSERVATION SAMPLE Y <br /> T <br /> F A <br /> U <br /> EXCAVATION SIZE: Z X 2 X YDS OF SOIL: <br /> Ivo <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE @ <br /> N P <br /> S P I <br /> L P <br /> I E <br /> I/I C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> O H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 M OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: <br /> J Ll <br /> LABORATORY: SAMPLERS NAME: <br /> LI: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> Ell 2;1 04:1(7/88) <br />