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i <br /> SJLHD — UND' OUND 'TANK CLOS UHS/A ILAN DC " -4T INSLJLl;'1'lU, <br /> l Sf1ADED Af<�'-TO BE FILLED IN FOR TRE ....4..iT TANK ONLY) <br /> TIP! <br /> O M As 7�2uc r nr G= 3 Alm fir <br /> G OWNER' NAME DE':" /2 u `'� <br /> E Gf�F�Dke OWNER PHONE r 4 <br /> N CONTRACTOR M ��T � CON. PHONE# , -71"?- <br /> Z <br /> E nl <br /> R SJLHD PERMIT # EPA # ' <br /> LI E ERM T # $ <br /> INSPECTOR/ <br /> ,V,< DATE x_20- TANK # 39 <br /> R RINSED (YIN) METHODS FRINSE AMOUNT -5 d p �- <br /> . I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIF9ST # -OR- OTHER <br /> • V VAPORS PURGED (YIN) METHOD ; ., ,. AMOUNT USED <br /> •P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL,--IIBERCLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION GOOD, POOR, HOLES) <br /> P N <br /> I S PIPE MATERI (STEEL, FIBERGLASS, OTHER) I FEET N 8 <br /> P T <br /> I PIPING CONDITIO (G00 , POOR, HOLES) <br /> N <br /> G T DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> F A r <br /> I N S <br /> E K <br /> L <br /> D EXCAVATION SIZE: X X YDS OF SOIL: <br /> S- <br /> I A• DEPTH SOIL TYPE OBSERVATION AMPLE # <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 G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 1 OF HOURS SINCE DEWATERING: <br /> aOTHER SAMPLE: <br /> LABORATORY: !A 1vdq I e- SAMPLERS NAME: �L <br /> CLOSURE. IN PLACE MIXTURE: VOLUME: <br /> )-.If 2.1 01,1(7/88) DRAW SITE MAP ON REVERSE <br />