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SJLHD - UNDgRGROUND 'TANK CLOSURE/AllANC"VMENT 1NS14EC-1-JUN <br /> (SHADED A 1 TO DE FILLED IN FOR THE QRST TANK ONLY) <br /> N NIVPi3c1/ RGµ/G�'- Ull S J T <br /> G OWNER NAME OWNER PHONE u <br /> E -�?oq <br /> N ' CONTRACTOR c P 0 CON. PHONEY ' <br /> E 2a7 -�z %653 <br /> R SJLHD PERMIT Y <br /> INSPECTOR eN f DATE �Z �0 TANK Y 39 <br /> R RINSED (Y/N) METHOD <br /> I RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST Y -OR- OTHER <br /> AV VAPORS PURGED ON) METHOD = AMOUNT USED <br /> 900 6s <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> A R COMMENTS i-, m <br /> N TANK MATERIAL IEEL 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) $ FEET <br /> p T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G T DEPTH SOIL TYPE OBSERVATION SAMPLE Y <br /> F A O r" A"� W. P✓ <br /> I N ! c' (1.4 4 5 <br /> E K <br /> L <br /> D EXCAVATION SIZE: c X X <br /> S. ,[--1_ YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE @ <br /> S p I <br /> P L p <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X <br /> I YDS OF SOIL <br /> O H DEPTH TO G.W. : <br /> N 2 FT SAMPLING METHOD <br /> 0 p OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: <br /> LABORATORY: 6a,l W1144 ds SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> V11 2, 01SER) DRAW SITE MAP ON REVERSE <br /> I , <br />