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E SJLHD - UNDERGROUND 'DANK CLO:;URE/AltAND-;h.NMENT INSYECTIUN <br /> (SHADED .1-' A TO BE FILLED IN FOR THE RST TANK ONLY) <br /> fo k+d r,i ' <br /> G OWNER NAME �. <br /> OWNER PHONE <br /> E _ _ 6 <br /> N CONTRACTOR 5 O CON. PHONE10 • <br /> 2Q9' -.�z -y653 <br /> R SJLHD PERMIT I EPA I FIRE PERMIT 0 <br /> L � � : <br /> INSPECTOR e 171i✓- DATE TANK 9 39 <br /> R RINSED (Y/N) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFRST # -OR- OTHER <br /> AV VAPORS PURGED �N) METHOD �� AMOUNT USED <br /> 700 fbs <br /> .P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> AT R COMMENTS , P� �� , <br /> N TANK MATERIAL tEEL, 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 DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE 0 <br /> F A W.4 Al <br /> I N ^ I -® G (44A 5 <br /> E K <br /> L <br /> D EXCAVATION SIZE: X <br /> S_ �X YDS OF SOIL: l� S <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X <br /> I X YDS OF SOIL <br /> OH DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 0 OF HOURS SINCE DEWATERING: <br /> OTHER SAMPLE: <br /> i <br /> LABORATORY: d6 SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> �;�( 2 04`-../88) DRAW SITE MAP ON REVERSE <br />