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2 <br /> SJLHD - UND ROUND 'TANK CLOSURE/AIWANDI INT 114S11EC'lloo <br /> (SHADED AR TO BE FILLED IN FOR TJ IL UM V <br /> ' ST TANK ONLY) <br /> � Gli . <br /> G 70 <br /> OWNER NAM OWNER PHONE <br /> E <br /> CON. PHONE# ' �Z/j _ 3s�f' f <br /> N CONTRACTOR s or/ �f21//G� 57/97 <br /> E 2 <br /> R < SJLHD PERMIT 1 EPA N FIRE PERMIT <br /> LI " <br /> M. <br /> INSPECTOR DATE TANK 1 39 - <br /> R I RINSED (Y/N) METHOD RINSE AMOUNT <br /> • I <br /> N RINSATE DISPOSAL SITE <br /> SE MANIFEST 1 -OR- OTHER <br /> V VAPORS PURGED (Y/N) METHOD 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 ( STEEL, 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 /> l P Tpu n <br /> I PIPING CONDITION OOD POOR, HOLES) <br /> NSAMPLE 1 <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T <br /> F A <br /> I N <br /> E K <br /> LYDS OF SOIL: <br /> D EXCAVATION SIZE: X _ X _ <br /> S. SAMPLE 1 <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M PS <br /> S P I o„ G <br /> P L P <br /> E I E �z Z <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> O H DEPTH TO C.W. : FTSAMPLING METHOD <br /> N 2 <br /> 0 1 OF HOURS SINCE DEWATERING: <br /> aOTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME:/ <br /> r <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> )?II 2:1 0,1:1(7/88) <br />