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SJLHD — UNDLC:f"`'UHD TANK CLOSU4tL/1,ltANUUNM""` INt'L-LCTIUN <br /> (SHADED AREAQ_ BE FILLED IN FOR THE FIRJ TANK ONLY) <br /> G OWNER NAME l� OWNER PHONE M <br /> N CONTRACTOR f���c�-, CON. PHONE I Cl Ce 3 — '7Vt <br /> r <br /> E <br /> R { SJLHD RMIT G'94X�y�o�4` EPA I �� FIRE PERMIT I <br /> : � � � � M <br /> INSPECTOR C •o Z- DATE w f z 7=,— TANK 1 39 - / 0 5-0 - yl <br /> R RINSED GIN) METHOD ��� RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST -OR- OTHER <br /> V VAPORS PURGED ON)_TM o"� AMOUNT USED <br /> A <br /> p L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> O <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL T FIBERGLASS, OTHER) TANK SIZE dordc�J � <br /> K C <br /> / 0 TANK CONDITION (GOOD,(PO , HOLES) <br /> p N <br /> I SPIPE MATERIAL tl FIBERGLASS, OTHER) I FEET 2-0r <br /> P T <br /> I PIPING CONDITION (GOOD, s R HOLES)' <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION - SAMPLE 9 <br /> T <br /> F A /9' .G� �� //V <br /> I N i. • u /i�17 <br /> L <br /> .-7 SrC!cfc I I� <br /> D EXCAVATION SIZE: 30" X X YDS OF SOIL: <br /> 3y <br /> I A,' S DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> N } <br /> P <br /> C <br /> T TRENCH DIMENSION X X �!� YDS OF SOIL c�r��,� `7SYe <br /> I <br /> O H DEPTH TO G.W. : FT; SAMPLING METHOD <br /> N <br /> i <br /> 0 OF HOURS SINCE DEWATERING: <br /> aOTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME. <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ;ON REVERSE <br /> EH 23 043{7/88} <br />