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J <br />SJLHD - UND GROUND 'TANK CLOSURX/AI)ANDC 'ENT INSYL•CT1UN <br />(SHADED ARz% TO BE FILLED IN FOR THE FIRST TANK ONLY) <br />DRAW SITE MAP ON RL•'VERSP <br />yve N, <br />G OWNER NAME - <br />OWNER PHONE Y <br />N <br />f CONTRACTOR�nGev EnyJc <br />Town Cau.r/� <br />"Z:ON. PHONEY vS4/ <br />E <br />R <br />< SJLH PERMIT tl llL Y F�IRE PERRMITf�9 <br />L <br />�EPAr <br />_a 6v fit a d S f N[Pm fi M ft [t7Y- ^ I2 i ,It4 . <br />INSPECTOR L <br />DATE /O'S�y <br />"TANK Y 39 - - <br />R <br />I <br />RINSED (Y/N) METHOD RINSE AMOUNT <br />N <br />S <br />RINSATE DISPOSAL SITE <br />E <br />MANIFEST I -OR- OTHER <br />V <br />A <br />VAPORS PURGED (Y/N) <br />METHOD <br />AMOUNT USED <br />P <br />0 <br />L.E.G. READING AT REMOVAL (MUST BE < 20%) <br />T <br />R <br />COMMENTS <br />A <br />_ <br />N <br />TANK MATERIAL (STEEL, FIBERGLASS, OTHER) <br />TANK SIZE <br />K <br />C <br />/ <br />O <br />TANK CONDITION (GOOD, POOR, HOLES) <br />P <br />N <br />I <br />S <br />PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) <br />tl FEET <br />P <br />T <br />I <br />PIPING CONDITION (GOOD, POOR, HOLES) <br />N <br />G <br />DEPTH <br />SOIL TYPE <br />OBSERVATION <br />SAMPLE tl <br />T <br />F <br />A <br />I <br />N <br />E <br />K <br />L <br />D <br />EXCAVATION SIZE: X X,, <br />YDS OF SOIL: <br />I <br />A <br />DEPTH SOIL TYPE OBSERVATION <br />SAMPLE OX, <br />N <br />M <br />P <br />P <br />Li <br />P <br />E <br />I <br />E <br />C <br />N <br />TRENCH DIMENSION 'X /2 X � <br />YDS OF SOIL <br />T <br />G <br />I <br />0 <br />H <br />DEPTH TO C.W.: FT SAMPLING METHOD <br />N <br />2 <br />0 <br />1 OF HOURS SINCE DEWATERING: <br />❑O <br />OTHER SAMPLE: <br />LABORATORY: ^ <br />SAMPLERS NALE or Cmnrs2 <br />CLOSURE IN PLACE <br />I MIXTURE: <br />VOLUME: <br />DRAW SITE MAP ON RL•'VERSP <br />