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SJLHD - UNf -'20UND TANK CLOSURE/AUND '''NT INSPE:C-I-10N <br /> (SHADED ANw. TO BE FILLED IN FOR THE )'f.,z; ' TANK ONLY) <br /> ME <br /> ic��rf f oCoc113 £ CIC <br /> G OWNER NAME OWNER PHONE # } <br /> E f�c�Prf ja�.,s 9��-390 �dgSZ <br /> N CONTRACTOR CON. PHONE# * �/� _ <br /> E Tri��►�l� <br /> R t SJLHD PERMIT # sL� '• <br /> EPA 1 969 FIRE PERMIT # 0 _Oz <br /> INSPECTOR C. DATE y�/ry TANK q 39 - .C' `I�'7 <br /> R RINSED (Y N) METHOD RINSE AMOUNT <br /> I es�u�r r,,,asL. 30� <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y/ ) METHODpr."' 2ce AMOUNT USED <br /> .A <br /> .P L.E.L. READING AT REMOVAL (MUST BE C 20%) <br /> 0 <br /> T R COMMENTS <br /> A --_ -:----- <br /> N FTAN MATERIAL STEEL FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / O TANK CONDITION (GOOD, POOR, HOLES) /�l � A), <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) -f <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION AMPLE # <br /> T <br /> NU i5L w1/d/J ��gl f' b.` /✓otFEt a? r� ERZ <br /> E K <br /> L <br /> D S EXCAVATION SIZE: H X X �- XDS OF SOIL: yU s <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I <br /> P L P <br /> E IE <br /> C N <br /> T . G TRENCH DIMENSION X X YDS OF SOIL -- <br /> I <br /> O H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> F70HHE:R <br /> SAMPLE: � � <br /> LABORATORY: in <br /> ,i CAeki P�(, lr�do SAMPLERS NAHE• ,l <br /> CLOSURE IN PLACE I MIXTURE: q5 7,12- VOLUME: - 67 -3962. <br /> DRAW SITE. MAP ON REVERSE <br />• I'll 23 0.11(7/88) <br />