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SJLHD — UNDE, ''OUND TANK CLOS URIs/AILANDOr,,i NT I N;;1'Ll;I'I uN � 9 r <br /> (SHADED AREh"-.'0 BE FILLED IN FOR THE Fllt o T TANK ONLY) <br /> 41111, <br /> os^Gr! ,-�.� " � 7��•l Gs� <br /> G OWNER NAME OWNER PHONE I <br /> N I CONTRACTOR CON. PHONE# ' <br /> E <br /> R I SJLHD PERMIT I N G�l3SZZStL FIRE PERMIT 0 <br /> L � � � � <br /> INSPECTOR / � DATE8c TANK @ 39 - �%5 Z- - > — <br /> _t_ <br /> R RINSED (Y/N) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE i <br /> S <br /> E MANIFEST M -OR- OTHER <br /> V VAPORS PURGED (Y/N) METHOD AMOUNT USED / <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST iE < 20%) <br /> 0 <br /> T R COMMENTS <br /> N TANK MATERIAL (STEEL, FIBERGLASS THER) TANK SIZE ,O <br /> K C <br /> / 0 TANK CONDITIO (GOOD, !OOR, HOLES) A <br /> P N - <br /> IT PIPE MATERIAL (STEEL FIBERGLASS OTHER) � FEET <br /> S <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G T DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> F A <br /> I NkZ 52- <br /> E K o zCo c <br /> L <br /> D EXCAV TION SIZE: XX /Z <br /> S_ ,- z 3 F YDS OF SOIL <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE t} <br /> S P I <br /> P L P _ <br /> E I E <br /> C N <br /> T G TRENCH DIM NSIONXYDS OF SOIL <br /> 0 H DEPTH TO G.W. : F <br /> N 2 SAMPLING METHOD <br /> 0 1 OF HOURS SINCE DEWATERING: <br /> OTHER SAMPLE: <br /> a <br /> LABORATORY: 5e C 6� 0 SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />