Laserfiche WebLink
SJLHD — UNDE4&OUND 'TANK CLOSURE/A1{ANDUN P IN!iPLG'l'lUN <br />SHADED MEA 'O BE FILLED IN FOR THE FI TANK ONLY) 0 <br />�7 `� <br />t � /i.1j7r%1 � <br />1�0 7F"IaMHS TIZIKL /N b' <br />y .S <br />G OWNER NAME PFLT� K� <br />OWNER PHONE u <br />U <br />Grl �a K�� jL�Q <br />E <br />2pq_—�/51110. <br />N CONTRACTOR h�T �� �� <br />CON. PHONEM' , uR <br />< <br />SJLHD PERMITEPA N I E PERMIT RLINSPECTORZye <br />DATE /-zo-ffyTANK <br />YR <br />RINSED (YIN) <br />METHOD %�/C� �/�/� <br />RINSE AMOUNT Sp 0 c <br />RINSATE DISPOSAL SITE <br />I <br />N <br />S <br />E <br />MANIFEST I -OR- OTHER <br />V <br />VAPORS PURGED (Y/N) <br />METHOD <br />AMOUNT USED v <br />A <br />P <br />L.E.L. READING AT REMOVAL (MUST BE < 208) <br />0 <br />T <br />R <br />COMMENTS <br />A <br />N <br />TANK MATERIAL ,;(STEEL,`FIBERGLASS, OTHER) <br />TANK SIZE /Q aaa8=qd <br />K <br />C <br />ff <br />/ <br />0 <br />TANK CONDITIONGOOD, POOR, HOLES) <br />P <br />I <br />N <br />S <br />PIPE MATERI (STEEL, FIBERGLASS, OTHER) <br />YFEET I <br />P <br />T <br />I <br />PIPING CONDITIO (GOO , POOR, HOLES) <br />N <br />G <br />DEPTH SOIL TYPE OBSERVATION SAMPLE Y <br />T <br />7 oa ox f✓ v� <br />F <br />A <br />I <br />N <br />E <br />K <br />L <br />D <br />EXCAVATION SIZE: -LL X X LL YDS OF SOIL: <br />I <br />A <br />DEPTH SOIL TYPE <br />OBSERVATIONAMPLE I <br />N <br />M <br />P <br />n _ <br />S <br />P <br />I <br />P <br />L <br />P <br />E <br />I <br />E <br />C <br />T <br />N <br />G <br />TRENCH DIMENSION t7 X X <br />YDS OF SOIL Q <br />I <br />O <br />H <br />DEPTH TO G.W.: FT <br />SAMPLING METHOD <br />N <br />2 <br />0 <br />1 OF HOURS SINCE DEWATERING: <br />0 <br />OTHER SAMPLE: <br />i <br />LABORATORY: AN41.j16 <br />SAMPLERS NAME: <br />CLOSURE IN PLACEMIXTURE: <br />VOLUME: <br />DRAW SITE MAP ON REVERSE <br />Ell 2.1 04:1(7/88) <br />