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Al <br /> SJLHD — UNDERf "IUND TANK C:LOSUHE/AliANDON## T IN:IL'i:CTIUN <br /> (SHADED AREA DE FILLED IN FOR TllEi FIR TANK ONLY) <br /> NS lo <br /> V t. AD <br /> E OWNER NAME OWNER PHONE <br /> N CONTRACTOR '�Ch� rZ 4 .a CON. PHONEv.. h <br /> E <br /> R t SJLHD PERMIT IEPA �6 �3 Z� FIRE PERMIT <br /> IN <br /> INSPECTOR DAT 3/� TANK ? 6 39 - /a/ - <br /> R RINSED N} HE OD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE I !� <br /> 5 <br /> E MANIF9ST -OR- OTHER <br /> V VAPORS PURGED Y ) METHODA!!�e ItC AMOUNT USED <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE C 20%) il <br /> 0 <br /> T R COMMENTS fi//P T Pic /-a u/S' a_s ;`r <br /> A G: 7,e �/ G✓. 4 GJ t�rS tww. <br /> N TANK MATERIAL TEE L FIBERGLASS, OTHER) ' TANK SIZE �p p <br /> K C <br /> / 0 TANK CONDITION (GOOD,LP <br /> OOR, HOLES) F�orc•s j`"l u LArC,� Z" ` <br /> P N TANrC rn� 3 Lco,7 .Ns . <br /> I 5PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) I FEET <br /> P T h <br /> I PIPING CONDITION (GOOD, POOR, HOLES) 'v <br /> N <br /> IF <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A p <br /> I N ruo " I aI <br /> E K it <br /> L li <br /> D EXCAVATIONSIZE: _2- X zL X 3 YDS OF SOIL: <br /> S: k <br /> I A DEPTH SOIL TYPE OBSERVATION !� SAMPLE <br /> N M P <br /> S P I I� <br /> P L P II <br /> C N- <br /> ii <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 1 OF HOURS SINCE DEWATERING: r# <br /> E[E:E:R::SAMPLE: <br /> LABORATORY: PSI-A �,ptig5SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON i?9VEh'SE <br /> Ell 2:1 011(7/88) i <br />