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SJLHD - UNDEROUND 'DANK CLOSURE/AILANDO NT INSt��:LTIUN <br /> (SHADED ARE1'0 BE FILLED IN FOR TIDE F T TANK ONLY) <br /> G OWNER NAME �- GNU: OWNER PHONE 1 <br /> E <br /> Ej CONTRACTOR -S -�G© CON. PHONE ' <br /> R c SJLHD PERMIT I EPA I FIRE PERMIT m <br /> L � <br /> INSPECTOR// DATE/v` _ �� TANK 9 39 <br /> R RINSED (Y/N) METHOD ERINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST I -OR- OTHER <br /> V VAPORS PURGED (Y/N) FMETHOD2� ZCe AMOUNT USED /S~ /000A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T I R JFCOMMENTS <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) FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES ) <br /> N <br /> G DEPTH S IL TYPE OBSERVATION 14 SAMPLE 0 <br /> TILIQ <br /> F A <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: X X YDS OF SOIL: <br /> 3- <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 H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 a OF HOURS SINCE DEWATERING: <br /> aOTHER SAMPLE: <br /> LABORATORY: cp L-, SAMPLERS NAME: <br /> i <br /> 11 <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE- <br /> 1.11 <br /> EVERSE].Z( 2:1 043(7/88) <br />