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SJLHD - UNDEfv'( 'qD 'TANK CLOSUIWAAANDON ' ' 1NSVECTIIJ l Z� r <br /> (SHADED AREA �' fE FILLED IN FOR THE !+'I R ANK ONLY) <br /> �� <br /> I7n 2 U - S7�GV <br /> G OWNER NAME {U1� OWNER PHONE b /- 0 :7-W <br /> E 1 r �D <br /> N CONTRACTOR CON. PHONE# ' 6 2 <br /> E <br /> R SJLHD PERMIT I EPA I FIRE PERMIT V <br /> L <br /> INSPECTOR. DATE / TANK Y 39 - 17- 73 <br /> R RINSED /N) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITErn I L Z{oAe, <br /> S <br /> E MANIFEST I -OR- OTHER <br /> V VAPORS PURGED Y N) METHODAMOUNT USED ' <br /> -A <br /> BIZ �r� <br /> • P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL STE FIBERGLASS, OTHER) TANK SIZE /,2006..) <br /> K C <br /> / 0 TANK CONDITION (GOOD POOR, HOLES) <br /> P N <br /> I JS PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) !i FEET <br /> P <br /> I PIPING CONDITION (GOOD, POOR, HOLES ) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A <br /> I N <br /> E K � <br /> L <br /> D EXCAVATION SIZE: 'L X X „� YDS OF SOIL: <br /> 3- <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE t <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 G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 I OF HOURS SINCE ,DEWATERING: <br /> OTHER SAMPLE: <br /> k <br /> LABORATORY: SAMPLERS NAME: <br /> i <br /> CLOSURE .IN PLACE MIXTURE: VOLUME: <br /> DRAW'SITE MAP ON REVERSE <br /> Elf 23 01:3(7/88) <br />