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SJLHD - U1QERGRQUUD TANK CLOS URE/AltANDON MENT INS1'L•:C'!'iUN <br /> (SFlIlDED AP TO BE FILLED IN FOR THE UST TANK ONLY) <br /> I S �� <br /> G r OWNER NAME ?? <br /> OWNER PHONE # <br /> E <br /> N CONTRACTOR <br /> E CON. PHONE# ' <br /> R { SJLHD PERMIT # EPA # FIRE PERMIT # <br /> INSPECTOR u DATE :TANK # 39 -- - a <br /> R RINSED Y N} METHO <br /> I D rt RINSE AMOUNT tv�acl <br /> FtTQSSUte Way�t GC► <br /> N RINSATE DISPOSAL SITE <br /> S S�rvke <br /> E MANIFEST # -OR- OTHER <br /> A VAPORS PURGED �N) METHOD �� AMOUNT USED 90 <br /> (6 1®ry <br /> . P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> O <br /> T R COMMENTS <br /> A <br /> NTANK MATERIAL STEE FIBERGLASS, OTHER) TALK SIZE <br /> K C <br /> / O TANK CONDITION GOOD POOR, HOLES) <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITIQN (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> I N <br /> C3 r <br /> E K <br /> L <br /> D EXCAVATION SIZE: 1 X X YDS OF SOIL: <br /> S- <br /> I A DEVl <br /> PTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <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 SAMPLING METHOD <br /> N 2 <br /> �0 # OF HOURS SINCE DEWATERING: <br /> LO OTHER SAMPLE: <br /> L'lIABbRATORY: �jL � SAMPLERS NAME <br /> Mark- [(- <br /> CLOSURE IN PLACE j MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />