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SJLHD - UN GROUND 'TANK CLOSURE/AUNU IL.N'1' 1[tSPEC'1'1UN <br /> (SvH(yAfDED A� TO BE FILLED IN FOR THE RST TANK ONLY) <br /> UM <br /> �/�/Y� LOOE'7 t ' •' Ncvei qe( <br /> T/ U <br /> G + OWNER NAME ER PHONE I <br /> E OWNER <br /> N ' CONTRACTOR <br /> E CON. PHONEY <br /> T/nor Off% <br /> R SJLHD PERMIT I EPA I <br /> INSPECTOR L� vy DATE �D�`1�8f TANK I 39 - Z2�0 <br /> - o <br /> R RINSED [YIN) METHOD �vr/p viii RINSE AMOUNT a <br /> N RINSATE DISPOSAL SITE <br /> S R /i Ser vLc�s <br /> E MANIFEST I -OR- OTHER <br /> V VAPORS PURGED (Y,jN) METHOD - <br /> A �6 /� AMOUNT USED lolls <br /> P L.E.L. READING AT REMOVAL (MUST BE C 208) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MA'1lRIAL STEEL <br /> K C FIBERGLASS, OTHER) TANK SIZE <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES) <br /> P N <br /> ' I S PIPE MATERIAL 0. TEE , FIBERGLASS, OTHER) I FEET <br /> P T <br /> I PIPING CONDITIO <br /> N N 0GO094 POOR, HOLES) <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE I <br /> F A <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: /a' X ' <br /> S-. _ ? X $ YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE I <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TR$NCH DIMENSION X X <br /> I YDS OF SOIL <br /> O H DEPTH TO C.W. : <br /> N 2 FT SAMPLING METHOD <br /> 0I OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: <br /> LABORATORY: / // SAMPLERS NAME <br /> LtJf�{C/ L� 3r/c J <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> 1?II 2:1 04,(7/88) <br />