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SJLHD -- UNDh 4 JND TANK CLOSURE/Al�1NDL� � IN:;L'Lc:'i'YuN <br /> (SHADED ARE TO DE FILLED IN FOR T!!E F ST TANK ONL ) <br /> ME <br /> G r OWNER NAME / OWNER PHONE >V <br /> E <br /> N CONTRACTOR � CON. PHONE# ' ��6 - X027-�� S� <br /> E : <br /> R t SJLHD PERMIT I EPA I FIRE PERMIT II <br /> L <br /> INSPECTOR DATES TANK " I 39 <br /> R RINSED (Y/N) METHOD I RINSE AMOUNT J <br /> N RINSATE DISPOSAL SITE H4 H <br /> 5 <br /> E MANIFEST II --OR—,1 . OTHER <br /> V VAPORS PURGED "�"Y ) METHOD AMOUNT USED <br /> A <br /> .P L.E.L. READING AT REMOVAL (MUST BE t 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL) FIBERGLASS, OTHER) TANK SIZE/, <br /> K C <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 Q-( DEPTH SOIL TYPE OBSERVATION SAMPLE I# <br /> T <br /> I PLA <br /> WA <br /> i EXCAVATION SIZE: ,�3 X X I�ji YDS OF SOIL: <br /> DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N P <br /> S P, I <br /> L P <br /> I• E <br /> V° 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 /> 0 # OF HOURS SINCE DEWATERING: <br /> OTHER SAMPLE: <br /> I <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> __jLDRAW SITE *MAP ON dEVERSE <br /> Eff 2:1 01.1(7/88) - - - <br />