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SJLHD -- UNDF"..ROUND 'TANK CLOSURE/AItANDO ..NT INSPECTION <br /> (SHADED ++AR, TO BE FILLED IN FOR TAC +F `{T' TANK ONLY) <br /> ����'S6'Y� ����•7F����3l��' '� YtY�Y�'76'L3� . " � . . . . . YSjF. f <br /> j G OWNER NAME OWNER P:HONE�'P i <br /> N r CONTRACTOR CON. PH4NEJ!� <br /> R < SJLHD PERMIT I EPA I FIRE PERMIT 0 <br /> , <br /> JG <br /> :r ,I <br /> INSPECTOR ' S DATE �� Ib :01 TANK I a 39 <br /> a <br />{ R RINSED Y N) METHOD r RINSE AMOUNT <br />{ I11 <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST I -ORS! OTHER <br /> V VAPORS PURGED /N) METHOD AMOUNT USED <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE 020%l k <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER),11 TANK SIZE <br /> K C '3 <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES) <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OT HER) I FEET <br /> P T �i p <br /> I PIPING CONDITION (GOOD, POOR, HOLES) SII <br /> N <br /> G DEPTH SOIL TYPE OBS V <br /> ER ATION SAMPLE � <br /> T' ;F <br /> F A I ik <br /> I N an ars. i. p <br /> E K <br /> L <br /> D EXCAVATION SIZE: X X YDS OF SOIL: <br /> S_ M <br /> I A DEPTH SOIL TYPE OBSERVATION ! Ig SAMPLE #� <br /> N M P h <br /> S P I i <br /> P L P E <br /> E I E 'k <br /> C N iE <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> 0 H DEPTH TO G.H. : FT SAMPLING METHOD <br /> N 2 I <br />` 0 1 OF HOURS SINCE DEWATERING: f <br /> OTHER SAMPLE: <br /> I� <br /> 1 LABORATORY: =IISAMPI' LERS NAME: <br /> 5 <br /> CLOSURE IN PLACE MIXTURE: �I VOLUME: <br /> DRAW SITE MAP ON KEVERSEIJ <br /> Ell 2:1 011:1(7/83) � <br /> Ic <br />