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SJLHD - UNC JUND 'TANK CLOSURL••/ A11pNDL ' T INSLS <br /> L' L '1' lUN I 7/o ;e2 <br /> ( SHADED ARI;j. _ 0 DE FILLED IN FOR THE Fl . � T TANK <br /> G OWNER NAME �� � N � OWNER PHONE Y 20 ��— -9/'J� <br /> E o ( ' <br /> N CONTRACCTOR ��/ CON . PHONEN <br /> E Wjck7v ) /✓ 0 9G7iN / <br /> R SJLHD PERMIT i G PA GAS FIRE PERMIT 061 <br /> INSPECT DATE 6 Zy�B TANK 0 39 <br /> R RINSED Y N ) METHOD t7 . RINSE AMOUNT <br /> I /�/ <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST I -OR - OTHER <br /> V VAPORS PURGED �l Y)N ) METHOD J) g �LG ,y AMOUNT USED <br /> A <br /> P L . E . L . READING AT REMOVAL ( MUST BE < 20 % ) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIA ( STEEL , � FIBERGLASS , OTHER ) TANK SIZE <br /> K c �. <br /> / 0 TANK CONDITIO ( GOODY POOR , HOLES ) <br /> P N <br /> I S PIPE MATERIAL ( STEEL , FIBERGLASS , OTHER ) 4 FEET <br /> P T <br /> I PIPING CONDITION ( GOOD, POOR , HOLES ) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE V <br /> T <br /> F A <br /> I N �- <br /> E K <br /> L <br /> D EXCAVATION SIZE : X X YDS OF SOIL : <br /> 3 - <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE f♦ <br /> N M P <br /> SP I Y 6w <br /> P L P .Slc D , OR' <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> i OH DEPTH TO G . W . : FT SAMPLING METHOD <br /> N 2 <br /> 0 1 OF HOURS SINCE DEWATERING : <br /> ❑O OTHER SAMPLE : <br /> LABORATORY : ~� SAMPLERS NAME : r pI ) <br /> i <br /> CLOSURE IN PLACE MIXTURE : VOLUME : <br /> 101 23 0 :1 ( 7 / 88 ) DRAW SITE MAP ON REVERSE <br />