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SJLHD - UNDE '(UUND TANK CLOSURE/AL(ANDON' :NT 1NSYECTIUN <br /> (SHADED ARE)ti,'O BE FILLED IN FOR THE Fi�T TANK ONLY) <br /> . i . . . . ` , <br /> G OWNER NAME °4;,, ,w .y,� OWNER PHONE I <br /> N IN <br /> < CONTRACTOR T� CON. PHONEI ' 2p� 41 <br /> E ��" YI 7�SiY1Qi <br /> R < SJLHD PERMIT I EPA I FIRE PERMIT 112hs�� <br /> INSPECTOR f�'.' DATE 717 y TANK I 39 - <br /> RINSED (Y/� METHOD RINSE AMOUNT <br /> RINSATE DISPOSAL SITE <br /> E <br /> MANIFEST I -OR- OTHER <br /> V VAPORS PURGED Y/ ) METHOD�>,,?,, eF 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 (STEEL FIBERGLASS, OTHER) TANK SIZE ) O;jU Cl-f)L <br /> K C <br /> / 0 TANK CONDITION (GOOD, POOR, HOLE <br /> P N <br /> I S PIPE MATERIALEEL, FIBERGLASS, OTHER) I FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, OLES) — P P X plo, <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE I <br /> T <br /> F A 17 -41 <br /> C L11411 Lopr'l <br /> I N Ini ^� 1 <br /> E K rJ <br /> L snotk <br /> D EXCAVATION SIZE: L X I74'X YDS OF SOIL: 3 jlS 3 <br /> 3- <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE IF <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 /> HFo-11 OTHER SAMPLE: �! <br /> LABORATORY: ei SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: 1 � VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />