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SJLHD - UNC '.GROUND 'TANK CLOSURE/A$AND( MEN'1' INS11EC'T1UN <br /> (SHADED A)1ftwA TO BE FILLED.. . . IN FOR THENK ONLY) <br /> MIS 1111111, ; <br /> 41 pe opew <br /> G OWNER NAME �* f f �� <br /> OWNER PHONE ZO /0 �- �� <br /> N CONTRACTOR c�1(/ CON. PHONE# <br /> EPA p FIRE PERMIT H <br /> R < <br /> S J L H D PERMIT tl C/aY4oa <br /> INSPECTOR JFAl/((� DATE3� � TANK V 39 —�-- <br /> R RINSED Y N) ME HOD RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST R S'ox o(blA0l - -OR- OTHER Fsw-x (U <br /> V VAPORS PURGED Y/ ) METHOD �� AMOUNT USED 3� JbS <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20$) o <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL TEEL, FIBERGLASS, OTHER) TANK SIZE u (� <br /> K C <br /> / 0 TANK CONDITI0 (GOOD POOR, HOLES ) <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) I FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE Y <br /> F A L 1' LpsnhJJ v i.(W ik <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: X X YDS OF SOIL : <br /> S. — <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE Y <br /> N M P <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION 5wl X &IX Jam/ YDS OF SOIL <br /> I <br /> 0moDEPTH TO G.W. : FT SAMPLING METHOD <br /> N I OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: <br /> HlLABORATORY: 40/dI? SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: 0� VOLUME: <br /> DRAW SITE MAP ON REVERSE: <br />