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SJLHU - UNULG 'UUNU 'TANK CL07SURi,/AL3ANUUN VT Iti ivECTlu[i <br /> (SHADED AREAS—,"O DF FILLED IN FOR THE FItz—,T TANK ONLY) <br /> pan =1zI --0 `: . . . . <br /> G OWNER NAME OWNER PHONE I j; 3 S3 <br /> E L yt <br /> N CONTRACTOR 4�NS CON. PHONE N ✓�f� �jl )/'��6 i. <br /> R SJLHD PERMIT I v/ EPA I FIRE PERMIT N <br /> L <br /> INSPECTOR�v - DATE �2 �j TANK I 39 <br /> R RINSED (Y/N) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST I -OR- OTHER <br /> V VAPORS PURGED (Y/N) METHO� � ZCE AMOUNT USED ,/ G <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 208) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE 3Q 00 U <br /> K C <br /> / O TANK CONDITIO (GOOD, POOR, HOLES) <br /> P N <br /> I S PIPE MATERIAL STEEL FIBERGLASS, OTHER) I FEET ,-201 Zc n' \ <br /> P T 1 <br /> I PIPING CONDITIO L <br /> OOPOOR, HOLES) <br /> N <br /> G U DEPTH SOIL TYPE OBSERVATION SAMPLE I <br /> F �! A <br /> I Q N <br /> E kK <br /> D N ` EXCAVATION SIZE: X l% X <br /> / �6 YDS OF SOIL: <br /> 3- <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE I <br /> N M P <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X _ X YDS OF SOIL <br /> I <br /> 0 H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 I OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: <br /> LiLABORATORY: f ' L 3 VtgSAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITF MAP ON REVERSE <br /> Ell 2:1 04:3(7/88) <br />