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SJLHD - UNDERGvmJND TANK CLOSURE•'/AIIANDONMI,f INSPLCTIUN <br /> (SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> GOWNER NAME 7 �/ OWNER PHONE 1 <br /> E X09 -�r3s - �zs <br /> N < CONTRACTOR ,QZ>�L CON. PHONEI ' <br /> R SJLHD PERMIT 1EPA Y FIRE PERMIT 1 <br /> L � <br /> INSPECTO22, DATES ,y TANK 1 39 - f`/U % - 3 <br /> R RINSED /N) METHOD "an RINSE AMOUNT <br /> • I I <br /> N RINSATE DISPOSAL SITE�G V/ /� "A7,A <br /> S <br /> E MANIFEST 1 -OR- OTHER <br /> V VAPORS PURGED (Y/ ) METHOD �� �C F 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 (STEE FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES) <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) 1 FEET <br /> P T <br /> IPIPING CONDITION (GOOD, POOR, HOLES ) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE 1 <br /> T <br /> F A <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: X �U X YDS OF SOIL: 3�l 4S <br /> S. <br /> I A DEPTH SOIL TYPE OBSERVATION SA PLE 1 <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 /> O H DEPTH TO G.N. : FT SAMPLING METHOD <br /> N 2 <br /> 0 1 OF HOURS SINCE DEWATERING: <br /> aOTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> i <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> RII 2:1 01:1(7/88) <br />