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SJLHD — UNDERC-Ff OUND TANK CLOSURE/AIW3 NDONML•:NT 1N:iPECTIUt't <br /> (S}IADED ARL' O BE FILLED IN FOR THE FI `T TANK ONLY) <br /> no <br /> ;; % lrf(.I.f(,T 1//1!J ire E�'=/��-' � .:•ti.+ G.;-+*.. !ri' <br /> G OWNER NAME c Q.clr- OWNER PHONE VGJ <br /> E <br /> N CONTRACTOR r CON. PHONEM <br /> R SJLHD PERMIT I EPA MFIRE PERMIT t[ <br /> INSPECTOR r. N; DATEi; rj•, r TANK M 39 - _< 5`7 l - C <br /> R RINSED (Y/N) METHOD:_O� PRINSE AMOUNT ? <br /> N RINSATE DISPOSAL SITE ,pr.,n.n� .x <br /> S <br /> E MANIFEST i -OR- OTHER <br /> V VAPORS PURGED N) METHOD �n +� AMOUNT USED ^ - N' s <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) ?� <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL FIBERGLASS, OTHER) TANK SIZE ,� �:� <br /> K C <br /> / 0 TANK CONDITION (GOOD,fP00 , HOLES <br /> p N <br /> I S PIPE MATERIAL (STEEL - FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE f) <br /> T f <br /> F A -7• faq �.7'n, n S/Mtjl 0rl CNfY111 !rt�r�L Imo? i<Gc rr 1 , r <br /> e C <br /> INt•l.nl• •'(iO' !'..I��ivrwni..n1^• '=r . '4-r-, _ <br /> E K <br /> L <br /> D EXCAVATION SIZE: � X '7� X q14" <br /> YDS OF SOIL: y <br /> 3- <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE <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.K. : FT SAMPLING METHOD <br /> N 2 <br /> 0 I OF HOURS SINCE DEWATERING: <br /> OTHER SAMPLE: <br /> LABORATORY:C,, fc- ,,G SAMPLERS NAME:LJ <br /> r <br /> CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> EI[ 2:1 0-1:3(7/88) <br />