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SJLHD - UNDERGROUND 'TANK CLOSURE/A4ANDONHEN'T IN51'1:1:'1'lUN <br /> . .(.SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> l" <br /> G + OWNER NAME OWNER PHONE 1 ,. <br /> N CONTRACTOR 5 ca CON. PHONE N . 3 y_ < <br /> E <br /> R SJLH PERMIT 1 <br /> 9� EPA 1 FIRE PERMIT N <br /> �. yf 11 <br /> INSPECTOR .C,aY DATE TANK 1 39 - rf <br /> I RINSED /N) METHOD _Z �/ RINSE AHOUN J ss <br /> y <br /> N RINSATE DISPOSAL SITE <br /> s 1 <br /> E HANIMST 1 -OR- OTHER <br /> V VAPORS PURGED N) METHOD <br /> .A AMOUNT USED ��6s <br /> •P L.E.L. READING AT REMOVAL (MUST BE < 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 OD, 00h, HOLES) <br /> • P N <br /> ` I S PIPE MATERIAL E L FIBERGLASS, OTHER) N FEET 23 <br /> J �P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE N <br /> F A is <br /> I <br /> N <br /> E K <br /> L <br /> D EXCAVATION SIZE: X G X l �i YDS OF SOIL: <br /> 9; <br /> I A DEPTH SOIL TY OBSERVATION <br /> �N H P SAMPLE 1 <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRF�NCH DIMENSIO _ X <br /> I YDS OF SOIL <br /> — <br /> O N DEPTH TO C.N. : FT SAMPLING METHOD <br /> N 2 <br /> 0 1 OF HOURS SINCE DEWATERING: <br /> L0 OTHER SAMPLE: <br /> LABORATORY: Geo SAMPLERS NAME: Chu <br /> CLOSURE iN PLACE MIXTURE:• VOLUME: <br /> - I� <br />