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SJLHD - UD' 'RGROUND 'TANK CLOSURE/AI(AN 4MENT 1NSPECTIUN <br /> (SHADED JhveA TO BE FILLED IN FOR THE*IRST TANK ONLY) <br /> � � =101 . = <br /> .Ae ai yi �s Sf E <br /> G OWNER NAME OWNER PHONE 1 <br /> E �fr. Tr,'. /.��%s _ 9y�- 9 3vi <br /> N CONTRACTOR CON. PHONEI ' <br /> R < SJLHD PERMIT 1 <br /> EPA Y Cn0o83/66adgFIRE PERMIT Y /3000 <br /> � � ysx : <br /> INSPECTOR DATE TANK 1 39 <br /> R RINSED (YIN) METHOD RINSE AM UNT <br /> I <br /> N RINSATE DISPOS L SITE <br /> S <br /> E MANIFEST I -OR- <br /> OTHER <br /> V VAPORS PURGED Y&J) METHOD a//-y lee AMOUNT USED /S/,6s <br /> A <br /> .P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> O <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL STE , FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION GOOD POOR, HOLES) <br /> P N <br /> I S PIPE MATERIAL STEE FIBERGLASS OTHER) TV FEET C �� <br /> P T <br /> I PIPING CONDITION (G00 POOR, HOLES ) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE I <br /> T <br /> F A irv,F � <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: _z X _L X 71d ' YDS OF SOIL: a <br /> N M P y 61' <br /> S; <br /> I A DEPTH SOIL TYPE OBSERVATIONSAMPLE @ <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X <br /> I ' YDS OF SOIL <br /> — <br /> 0 H <br /> N 2 DEPTH TO C.W. : FT SAMPLING METHOD <br /> 0 1 OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: �av� <br /> fCLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> 111 2:1 04:1(7/88) �//�� <br />