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SJLHD - UNDrj&"wUND TW <br /> 'TANK CLOSURE/Al41 )WINs Li L'cr I u N <br /> (SHADED ARI'VTO BE FILLED IN FOR THE I TANK ONLY) <br /> . . . . . . . . . .. <br /> ri?x 6 <br /> G OWNER NAME OWNER PHONE P ?'oc 71co)- <br /> E CON . PHONEN�3, 0 <br /> N CONTRACTOR?A,.j., <br /> E <br /> R k' SJLHD PERMIT I EPA FIRE PERMIT 0 . . ........ . <br /> '711, .11, .11 U-11 <br /> All, IN <br /> L T IR DATE 7 TANK 1 39 _ o / <br /> INSPECTOR <br /> R RINSED (Y METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S -OR- OTHER <br /> E MANIFEST I <br /> V VAPORS PURGED &N) METHOD AMOUNT USE <br /> A - T Bk < 20%) ;�� <br /> P L.E.L. READING AT REMOVAL (MUS 0 <br /> 0a4tU6 . -14- <br /> T R COMMENTS 4,451- i�'u lv� ?!_6614 <br /> A <br /> N TANK MATERIAL ( STEEL, FIBERGLASS, OTHER) TANK S'TZE <br /> K <br /> 0 TANK CONDITIONq�G�00D, POOR, HOLES ) <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) tl FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES ) <br /> N SAMPLE k <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T ti <br /> F A <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: j_j X X YDS OF SOIL : <br /> S-. <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE I <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 G.W. : FT SAMPLING METHOD <br /> 1 — <br /> N 2 <br /> 0 tl OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE HAP ON 9L'VEI?sr <br /> J.'ll 23 0-1'x(7/88) <br />