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SJLHD - UNDLFJ$UUND 'TANK CLOSURIi%AUANDUt%*T IIJLL!LCTlUN / <br /> (SHADED AREA PO DE FILLED IN FOR THE FIh-T TANK ONLY) J <br /> (', • � OWNER NAME <br /> ,�j�/�/Cvf /ZOs OWNER PHONE I ;ze .7 <br /> QuSt CON . PHONES ' <br /> N CONTRACTOR / r -G�✓d <br /> EEPA N FIRE PERMIT t! <br /> R SJLHD PERMIT M , . . <br /> L � . . . q <br /> TANK tl 39 <br /> INSPECTOR <br /> R RINSED (Y/N:) METHOD P/2 <br /> RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S -OR- OTHER <br /> E MANIFEST M <br /> V VAPORS PURGED (Y/N) <br /> METHOD AMOUNT USED <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> Aha G� <br /> N TANK MATERIAL (STEEL) FIBERGLASS OTHER) TANK SIZ <br /> Ow <br /> K C GVKeoS a✓ v <br /> / 0 TANK CONDITION (GOOD, POOR HOLES) � 7,0�/�' %esy� <br /> ' G� <br /> P NFEET <br /> o2Q r <br /> I S PIPE MATERIA (STEEL, FIBERGLASS, OTHER) Y <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES ) <br /> N SAMPLE Y <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T <br /> F A <br /> I N <br /> E K <br /> L / <br /> D EXCAVATION SIZE: 6 X S�iX YDS OF SOIL: <br /> 3: SAMPLE p <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P <br /> S P I <br /> P L P <br /> E I E <br /> C N " /L YDS OF SOIL 6 <br /> T G TRENCH DIMENSION /a X X L <br /> I <br /> p r H DEPTH TO C.W. : FT SAMPLING METHOD <br /> N <br /> 0 C OF HOURS SINCE DEWATERING: <br /> 2 : <br /> OTHER SAMPLE: <br /> ❑p <br /> LABORATORY: � SAMPLERS NAME: GA�elwlw <br /> VOLUME: <br /> CLOSURE IN PLACE MIXTURE: <br /> DRAW SITE MAP ON REVERSE <br /> Ell 2:1 043(7/88) <br />