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SJLHD — UNDERGROUND TANK CLOSURE/AL(ANDONHENT INSVE Cl'ION <br /> (SHADED AREA TO BE FILLED IN FOR Tit FIRST TANK ONLY) <br /> IV ff 1 , <br /> LUh gSs�,ir ✓J7 z�/u. f- %�G/s S-PvP��s; /_c�fl�r�o <br /> C t OWNER NAME ` OWNER PHONE Isd `� / 7J 11 <br /> E <br /> N CONTRACTOR _0 CON. PIIONEN <br /> E <br /> R SJLHD PERMIT Y EPA ICY cx>03v91r FIRE PERMIT N 91- C' <br /> INSPECTOR cl ,Ov ' DATE q/ TANK I 39 - /SOS - v-a- <br /> R RINSED MN) METHOD / e RINSE AMOUN <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFRST Y -OR- OTHER <br /> V VAPORS PURGED (YIN) METHODAMOUNT USED <br /> A i >'O/hs <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20% ) <br /> O <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL FIBERGLASS, OTHER) TANK SIZE <br /> K C - /i <br /> / 0 TANK CONDITION (GOOD, 0 , ' IDLES <br /> P N <br /> , I S PIPE MATERIAL <br /> P T FIBERGLASS, OTHER) Y FEET <br /> I PIPING CONDITION (GOOD, POOR,/ <br /> HOLES ) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE Y <br /> T <br /> F A <br /> I N i � - <br /> E K <br /> L <br /> D EXCAVATION SIZE: X _ti. X <br /> Si' YDS OF SOIL : <br /> - <br /> I A DEPTH SOLL TYPE OBSERVATION SAMPLE I <br /> N H P <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T C TRENCH DIMENSION X )`i X YDS OF SOIL <br /> I <br /> O H DEPTH TO G.H. : FT SAMPLING METHOD <br /> N 2 <br /> 0 I OF HOURS SINCE DEWATERING: <br /> Fol OTHER SAMPLE: <br /> LABORATORY: SAHPLERS NAHE: <br /> Co G a f rc Ld, <br /> CLOSURE IN PLACE MIXTURE:• VOLUME: <br />