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SJLHD - U110hF+ ROUND 'TANK CLOLUidi/AAANDUNP"•:NT 1NLJEC'T1UN <br /> (SHADED ARE..ro HE FILLED IN FOR THE F1 T TANK ONLY) <br /> R Pill" <br /> � - <br /> `JTEVFAK_1{T)GHneR4r <I Sr $Rppt510L� 5M14 <br /> G < OWNER NAME5rEJLIVS06 OWNER PHONE R ZaI SI <br /> E <br /> N CONTRACTORWe- 4�) M CON . PHONERTeg <br /> R SJLHD PERMIT B EPA t — FIRE PERMIT u )ZSZCo <br /> INSPECTOR ,�oL� DATE lz�q /* TANK 1 39 - SZL— <br /> R RINSED (Y.J METHOD -- RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER ` <br /> V VAPORS PURGED (�N) METHOD lCE AMOUNT USED (PO �� <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) - <br /> 0 <br /> T R COMMENTS — <br /> A <br /> N TANK MATERIA ( STEEL FIBERGLASS, OTHER) TANK SIZE gt✓ <br /> K C <br /> / 0 TANK CONDITION OOD, POOR, HOLES ) No eVtvWAC,E of cofCRr5io111 No HOLES <br /> P N <br /> l I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) M FEET NUNS <br /> J P T ; - <br /> I PIPING CONDITION (GOOD, P66A, - -ROLES ) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE @ <br /> T <br /> F A 1-3 ALL 500, w <br /> I NE <br /> E K - � L l0 <br /> L <br /> D EXCAVATION SIZE: �1�X -J,2X YDS OF SOIL : dS3 <br /> S-_ <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <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 DEPTH TO G.W. : FT _ SAMPLING METHOD NONE TAC1-W <br /> N 2 e L� <br /> 0 1 OF HOURS SINCE DEWATERING: <br /> aOTHER SAMPLE: <br /> Y: 0,41, � SAMPLERS NAME: — <br /> CLOSURE IN PLACE MIXTURE: A)/& VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> ]?II 2:1 013(7/88) <br />