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SJLHD UND04f#OUND 'DANK CLOSURE/ABANDO T INSPEC`PIUN 1 <br /> SHADED ARS TO ,BE FILLED IN FOR THE T TANK` ONLY) <br /> E G OWNER NAME ur uu s OWNER PHONE # , <br /> E <br /> N CONTRACTORCQ�?� CON. PHONE# -2 <br /> ECAC COO- <br /> R ; SJLHD PERMIT I EPA # oo '+ 7 FIRE PERMIT # <br /> L � � . . . . . . . . <br /> ► <br /> INSPECTOR C Hu DATE 6/�; �g� TANK # 39 - 3 2- - Oz <br /> R RINSED (Y ) METHODS o RINSE AMOUNT drum <br /> I <br /> N. RINSATE DISPOSAL 'SITE <br /> E MANIFEST # -OR- OTHER go-C-e,f 4b <br /> jp <br /> V VAPORS PURGE (Y/ ) METHODC� AMOUNT USED' 2S <br /> A . <br /> P L.E.L. READING AT. REMOVAL (MUST BE C 20%) <br /> 0 <br /> T LRJ <br /> COMMENTS <br /> % N TANK MATERIAL TEE FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / O TANK3CONDITION (GOOD, POOR, HOLES) <br /> P N <br /> I LS PIPEMATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> PIPIPING CONDITION A GOOD, POOR, HOLES) <br /> i N <br /> G DEPTH SOIL TYPE OBSERVATION 'SAMPLE # <br /> T I© o n Ca <br /> ; F � A <br /> E K <br /> L <br /> D EXCAVATION SIZE: S"7 X 13 X YDS OF SOIL-: <br /> S- <br /> : I A DEPTH SOIL -T.YPE OBSERVATION SAMPLE # <br /> ; N M P <br /> S P I <br /> P L P <br /> C N <br /> T G TRENCH DIMENSION- X X. YDS OF SOIL <br /> I <br /> 0 H DEPTH TO G.W : FT SAMPLING METHOD <br /> N 2 <br /> fl I OF HOURS SINCE DEWATERING: <br /> THER SAMPLE- <br /> a O <br /> r LABORATORY: e4 ,tl.ut,� �Q� SAMPLERS NAME: s:rd <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> Ell 23 0-13(7/88) <br />