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'SJLHD - UND""GROUND TANK CLO:;UUE./ALtAND- 'f•ENT INSYE:C1•I(jN <br /> (SHADED Al ^ w TO BE FILLED IN FOR THE EST TAN1f <br /> ONLY) <br /> .. � sr• r < <br /> G OWNER NAME OWNER PHONE I <br /> E r M, �eG, ys�rl,s D a. -94,go <br /> 4 <br /> N 4 CONTRACTOR CON. PHONE ` + � <br /> E 1 W, a ani - 31 ESIO ` <br /> R i SJLHD PERMIT II EPA II FIRE <br /> L 2•' . PERMIT # p b <br /> INSPECTOR uN DATE g�:�4�£� TANK 9 39 - - �_- <br /> R RINSED Y N) METHOD <br /> I IWILs ,t re cur, GRINSE AMOUNT <br /> 3 RINSATE DISPOSAL SITE Rle4;�Ps- <br /> S rvrc.e., P� t&f)N <br /> E MANIFEST # -OR- <br /> OTHER <br /> AV VAPORS PURGED N) METHOD AMOUNT USED <br /> P L.E.L. READING AT REMOVAL (MUST BE C 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL FIBERGLASS' OTHER) TANK SIZE <br /> K C <br /> / 5000 <br /> 0 TANK CONDITION GOOD POOR, 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 <br /> SAMPLE # <br /> T <br /> F r: A s N. <br /> r GL a <br /> A �i o�` .cCr c ct-c :.., <br />'4 E K <br /> LC• c..x <br /> D E3CCAVATION SIZE: 3 x x <br /> g_ YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I T Learn a^ e. <br /> P L P ' r if xz"IN <br /> � /i r•rSGr'r1Q'tr�/G� n <br /> CL- <br /> E I E x' z <br /> C N obSEi^t�c � <br /> rr <br /> T C TRENCH DIMENSION Ur- X 1' X. 3` YDS OF SOIL. <br /> x <br /> 0 H DEPTH TO C.W. : <br /> N ��� F+I► SAMPLING METHOD <br /> 2 ' <br /> OF HOURS SINCE DEWATERING: <br /> aOTHER SAMPLE: <br /> LABORATORY: FGA 'zci� ' q`�"z -olSl <br /> SAMPLERS NAME-. fug <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br /> DRAW SITE MAP ON R'EVERSI: <br />