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SJLHU - UNDkI UNU TANK CLOSUHk:%A1AANDUn I. INSLjLC'1'� i �f <br /> (SHADED AREA . 0 BE FILLED IN FOR THE I'I.. T TANK Y <br /> OWNER PHONE <br /> G OWNER 'NAME F/V/P/Glut <br /> N CONTRACTO a� CON. PH NEI <br /> R SJLHD PERMIT f EP�1 N r10�/35�o FIRE PERMIT Y <br /> 20=4 IN <br /> INSPECTOR y TANK Y 39 - / a 7 - <br /> R RINSED (Y/ RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S -OR- OTHER <br /> E MANIFEST @ <br /> V VAPORS PURGED (Y/N) METHOD AMOUNT USED <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20$) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEELF �RGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOO , POOR HOLES )" % ✓�– <br /> p NET / ✓�K it <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) I FEETQ /S <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> NSAMPLE Y <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T 7i <br /> F A <br /> I N <br /> E K <br /> LX YDS OF SOIL: <br /> D EXCAVATION SIZE: __ X <br /> S1. SAMPLE I <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P <br /> S P I <br /> p L P <br /> E 1 E <br /> C NX �_ X 2 <br /> / YDS OF SOIL <br /> T G TRENCH DIMENSION 1j�" <br /> IFT SAMPLING METHOD <br /> i 0 H DEPTH TO G.W. : <br /> N 2 <br /> 0 p OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> yes- 7 3-6" 60 SAMPLERS NAME�v <br /> LABORATORY:— y <br /> � VOLUME: <br /> CLOSURE IN PLACE MIXTURE: <br /> DRAW SITE MAP ON REVERSE <br /> .... .. . nn•�!7 /RRl <br />