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SJLHD - UN"GItOUND 'TANK CLOSURE/ALjAN#MLN'I' INSL'LC'1'1UN <br /> (SHADED AN-WA TO BE FILLED IN FOR THE rIRST TANK ONLY) <br /> v���(I�]�(1��((v��']/��[�{�' �'��vt��t�'�it�t ,'�'.�'�it�'.�2���a���ti• - - " �2�+'�+�it���dy"���t'.�it�'�i'- •C�7���=��t'.-�-�?��t'l�? <br /> Jl lli lY�\ ' ' • .�J(Cyy�fy( <br /> G OWNER NAME <br /> OWNER PHONE y �' <br /> N CONTRACTOR ,) <br /> E /i s` Cvhsi CON. PHONEY <br /> R SJLHD PERMIT y <br /> y, y, yE�PA y yF,IRE PERMIT yy ���yy <br /> A �t�t (tLv�cty1'��d � � �N ����� 9'���oli��Y C�-�i��1tL , <br /> L � ��. � . . ,fit= �. . . . ;��. : .y� .�� • : ; . : . . : . . • . . . . : <br /> INSPECTOR , DATE ,��y� y TANK Y 39 <br /> R RINSED (�YfN) METHOD <br /> I �r /P wa�ci RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST y <br /> -. -OR- OTHER <br /> V VAPORS PURGED �Y/N) METHOD - <br /> A �� ��if AMOUNT USED <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) s <br /> 0 <br /> T R COMMENTS <br /> A <br /> K C TANK MATERIAL `(STEEL,, FIBERGLASS, OTHER) TANK SIZE <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES ,/ <br /> / �>�)� <br /> P N _ <br /> I S PIPE MATERIAL (STEEL, 'FIBERGLASS, OTHER) y FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE p <br /> F ' <br /> I N <br /> E K - � <br /> L <br /> D EXCAVATION SIZE: <br /> S; X X YDS OF SOIL: <br /> I A �Cu- C�S <br /> N M P DEPTH SOIL TYPE OBSERVATION <br /> SAMPLE y <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> I G TRENCH DIMENSION X <br /> X YDS OF SOIL <br /> VH DEPTH TO C.K. : FT SAMPLING METHOD <br /> N 2 <br /> 0 1 OF HOURS SINCE DEWATERING: <br /> OTHER SAMPLE: <br /> LABORATORY - F <br /> SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE• <br /> VOLUME: <br /> 1?II 23 04.'1(7/811) DRAW SITE MAP ON REVERSE <br />