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SJLHD — UNDE tND TANK CLOSURE/AL"D2 t�::t�El."t't uta <br /> (SHADED AREA TO BE FILLED IN /FOR <br /> THE F4IR TANK ONLY) <br /> .140 <br /> 41, <br /> G OWNER NAME OWNER PHONE 1 <br /> E <br /> N CONTRACTOR CON. PHONE# <br /> E <br /> R aJLHD PERMIT 1 EPA 1 FIRE PERMIT 1 <br /> .�. .._... .. a <br /> INSPECTOR ^ �t; DATE-2 r_�-� TANK 1 39 - <br /> RRINSED (( ) METHODS RINSE AMOUNT�S� +� <br /> . 1 <br /> 71 <br /> N RINSATE DISPOSAL SITEC- <br /> S <br /> E MANIFFST 1 -OR- OTHER <br /> V VAPORS PURGED } METHOD ` AMOUNT USED2 w <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST DE C 20%) <br /> O <br /> T X. COMMENTS <br /> A <br /> N TANK MATERIAL /t STE , FIBERGLASS, UTHEa) TANK S I YE ���4U <br /> K C <br /> / 0 TANK CONDITION &� D POOR, HOLES} <br /> P N <br /> 1 S PIPE MATERIAL (STEEL, FIDERGLASS, OTHER) 1 FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE 1 <br /> T o/ <br /> F A <br /> E K <br /> L <br /> D EXCAVATION SIZE: J.Z-x Y- -x YDS OF SOIL: <br /> a- <br /> I A• DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> N M P <br /> S P I <br /> P L Q <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> O H ORPTH TO C.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 1 OF HOURS SINCE DRWATERING: <br /> OOTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br />