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SJLHD - UNDE ROUND 'DANK CLOSURE/ALJANDONT 114SPEC TUN <br /> (SHADED AREWTO BE FILLED IN FOR THE F ;T TANK ONLY) <br /> J � i { iJJ <br /> 1 <br /> G OWNER NAME OWNER PHONE 0 <br /> E <br /> N < CONTRACTOR CON. PHONE# <br /> E <br /> To <br /> R < HD PERMIT I EPA 4 FIRE PERMIT q <br /> L `'n " anal - <br /> INSPECTOR DATE TANK Y 39 - - 0 <br /> R RINSED N) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> MANIFEST I -OR- OTHER <br /> E <br /> V VAPORS PURGED (Y N) METHOD(o AMOUNT USEDi <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (ST , FIBERGLASS, OTHER) TANK SIZE�Cj <br /> o <br /> K C <br /> / 0 TANK CONDITION (GOOD,(PO , HOLES ) <br /> P N <br /> „I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) 9 FEET��/A <br /> P T <br /> IPIPING CONDITION (GOOD, POOR, HOLES) C�q <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE R <br /> T <br /> F A IZZ 0 <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 Ii X /i X YDS OF SOIL <br /> I <br /> 0moDEPTH TO G.W. : FT SAMPLING METHOD <br /> N <br /> N OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY t SAMPLERS NAME <br /> iLF <br /> CLOSURE IN PLACE I MIXTURE: VOLUM <br /> DRAW SITE MAP ON REVERSE <br />