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SJLHD - UNJr AGROUND 'TANK CLOSURE/AUAND. "MENT INSV' CTIUN <br /> (SHADED AR-A TO BE FILLED IN FOR THE ,RST TANK ONLY) <br /> J <br /> r ? <br /> G OWNER NAME OWNER PHONE I <br /> E <br /> N CONTRACTOR <br /> R CON ' 'PHONEN - < <br /> R SJLHD PERMIT I_. EPA l# FIRE PERMIT V <br /> INSPECTOR DATE 1 �'I TANK if 39 - 154 O Z <br /> R RINSED (Y4i ___- METHOD = �--- •- RINSE AMOUNS~- <br /> - I - <br /> N RINSATE DISPOSAL SITE <br /> E MANIFEST 9 -OR- OTHER <br /> r - <br /> F <br /> VAPORS PURGED 'N) "METHOD AMOUNT USED <br /> (J <br /> L.E.L. READING AT REMOVAL -(MUST BE < 20%) <br /> i <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL ' TEEL' FIBERGLASS, OTHER) TANK SIZE <br /> K C. <br /> 0 TANK CONDITION (GOOD R, HOLES) <br /> P N <br /> I S, PIPE MATERIAL STEEL * FIBERGLASS, OTHER) I FEET 'Z5 <br /> . 1 Q' T _ <br /> J L PIPING CONDITION (GOOD,`POOR, ' OLES) <br /> N <br /> G DEPTH ' SOIL TYPE `OBSERVATION SAMPLE i <br /> FA 1 w r, r Yv ti s c��_ >^ <br /> F N F <br /> E <br /> LK <br /> D EXCAVATION - SIZE:" 0- X X YDS OF SOIL: <br /> I A EPTH SOIL TYPE 'OBSERVATION - - -` - "SAMPLE p <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 /> O H DEPTH TO G.W. :` FT .. m ` SAMPLING METHOD' <br /> N 2 <br /> 0 1 OF HOURS SINCE DEWATERING: ., <br /> r <br /> OTHER SAMPLE: - k i <br /> I' LABORATORY: SAMPLERS NAME: <br /> ___FCLOSURE IN PLACE MIXTURE: VOLUHE: <br /> �j DRAW SrTE MAP ON REVERSE <br /> Ell x2:3 0,13(7/88) <br /> .0i� i'Iitt' ll[r f[GYCatSC: <br /> Ell 2:3 0,11(7/88) � <br /> i <br /> I� <br />