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SJLHD - UN ;GROUND 'TANK CLO[;Ul(X/AAANL 111.11'!' i1JG11Ec.I.lUN <br /> (SHADED ARTA TO DE FILLED IN FOR THE FIRST TANK ONLY) <br /> �flC�-fin �pp.� <br /> G OWNER NAME <br /> E OWNER PHONE I <br /> N CONTRACTOR <br /> E CON. PHONEtl <br /> R SJL D PERMIT I EPA I <br /> ya FIRE PERMIT tl <br /> L . . . . . = <br /> INSPECTOR ,p DATE Zil� �?/ TANK Y 39 3 <br /> R RINSED (Y N) METHOD/r�� �� � RINSE AMOUNTI(V <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST M Z -OR- OTHER <br /> V VAPORS PURGED Y N) METHOD <br /> A AMOUNT USED <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) Le( _(� 0,2 <br /> O <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL ( TEE , FIBERGLASS, OTHER) TANK SIZE g �� � <br /> K C <br /> PN TANK CONDITION (GOOD, P00 , HOLES) j5nv- 1/6ft5il A fv <br /> I S PIPE MATERIA (S EL FIBERGLASS, OTHER) W� tl FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEIL TYPE OBSERVATION SAM E tl <br /> T <br /> F A ' •, 1' 1 aA2z, Ea. <br /> I N Wei t <br /> E K <br /> L <br /> D EXCAVATION SIZE: / <br /> S X X YDS OF SOIL : <br /> I A DEPTH SOIL TYPE <br /> N M P OBSERVATION SAMPLE p <br /> / <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION XX YDS OF SOIL <br /> I --- <br /> 0 H DEPTH TO C.W. : FT SAMPLING METHOD <br /> N 2 PAII <br /> 0 tl OF HOURS SINCE DEWATERING: vJ <br /> ❑O OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAM Ll <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> 1`11 2:1 04:1(7/811) DRAW SITE MAP ON REVERSE <br />