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TANK N -* , 6 <br /> SJLHD - UNf UUND LANK CLOSUItIr/A11AND M1 IN.;1 L'l:'1'luN <br /> (SHADED A1'%*A--7'0 BE FILLED IN FOR TUE �irdT TANK ONLY) � <br /> a� . V O N <br /> ' O F_L7fl 'T,2liC� 5 Cf i <br /> E OWNER NAME F.ed� �D OWNER PHONE <br /> 7 b <br /> E CONTRACTOR CON. PHONE N '�� l�� 2-�s8� <br /> R SJLHD PERMIT I EPA N M 6 DJ <br /> L - : <br /> A � ¢. <br /> INSPECTOR DATE / ���-' TANK V 39 - --1 .6 f2- <br /> R RINSED (YIN) METHOD �, RINSE AMOUNT Qr <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST Y -OR- OTHER <br /> V VAPORS PURGED (YIN) METHOD ` AMOUNT USED <br /> •A <br /> •P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIA -`(STEELS,,FIBERGLASS, OTHER) <br /> K C TANK SIZE <br /> / 0 TANK CONDITION((GOOD, POOR, HOLES) <br /> P N <br /> �.. I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) N FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> T <br /> F A d' d <br /> E K <br /> L <br /> D EXCAVATION SIZE: X /q X L YDS OF SOIL: <br /> s: <br /> I A DEPTH SOIL TYPE OBSERVATION SAM LE I <br /> N M P <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> ' 0 H DEPTH TO C.W. : FT ---fSAMPLING METHOD <br /> N 2 <br /> 0 1 OF HOURS SINCE DEWATERING:• <br /> r 07— <br /> OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: J b f�v <br /> CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVEI?SE <br />