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. .. SJLHD - UMDERC( `f`"''U TANK CLOSURE/Al�ANDONM( � �lN:;l'L•'{�'1'luU �� <br /> (SHADED AREA FILLED IN FOR THE h'IIt- NK ONLY) � <br /> MIN <br /> • ..� A� v v� S7a � Gnu� R7 1 G� �'� <br /> G OWNER ,NAM 7 D s7a� o� OWNER PHONE @ 6_ I <br /> E r i <br /> E < CONTRACTOR �i � � L CON. PHONED , <br /> R t SJLHD PERMIT @ EPA @ FIRE PERMIT @ 1- 7S- <br /> Lft <br /> INSPECTOR/ DATE/ TANK @ 39 - �y�' - _L— <br /> R RINSED Y N3 METHOD '�� RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE; <br /> S <br /> E MANIFEST Y -OR- OTHER <br /> V VAPORS PURGED Y N) I METHOD/),eV. 7�CC: AMOUNT USED j <br /> A <br /> P L.E.G. READING AT REMOVAL (MUST E < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> NTANK MATERIAL STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K FN/ TANK CONDITION (GOOD POOR, HOLES) <br /> P <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 SAMPLE @ <br /> T _ s <br /> F A ' c-�(.o--v Z <br /> I N <br /> E K yw <br /> L / <br /> D EXCAVATION SIZE: :LQ X X YDS OF SOIL: <br /> S; <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE it <br /> N M P <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> 0 H DEPTH TO C.W. : FTSAMPLING METHOD <br /> N 2 <br /> 0 I OF HOURS SINCE DEWATERING: <br /> aOTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME:\7oEL <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE .MAP ON REVERSE <br /> Ell 23 0,13(7/88) <br />