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SJLHD -- U"DERGRUUND TANK CLOaURE/}iliANDO 114ENT I N PEC TI UN , <br /> (SHADED A TO BE FILLED IN FOR THE �7ST TANK ONLY) <br /> . � ml. : <br /> EG OWNER NAME / OWNER PHONE # <br /> N CONTRACTOR ��.vlrcYypr� ^r C�'J ti,PPr�nr CON. PHONEM ' <br /> R SJLHD PERMIT I EPA 1(4 a�( rl{scGter <br /> FIRE PERMIT # <br /> L �L' ` mac w t rig �truP <br /> INSPECTOR DATE TANK U 39 — 3j _ of <br /> R RINSED / } METHOD <br /> I CIp��PE �Y�i� t. rc�ssRINSE AMOUNT / <br /> N RINSATE DISPOSAL SITE <br /> S /��7/Mt/x ,"Y�IC Pte' ✓ry r^ <br /> E MANIFEST I —OR— OTHER <br /> V VAPORS PURGED { /N} METHOD AMOUNT USED <br /> A Drz r,, 3af,16� <br /> P L.E.L. READING AT REMOVAL (MUST SE C 20%) <br /> 0 <br /> T LR COMMENTS <br /> A <br /> L <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K C ��,0 <br /> l 0 TANK CONDITION OOD POOR, HOLES) <br /> P N <br /> I S PIPE M [:T# F7EET <br /> ATERIAL {STEEL, FIBERGLASS, OTHER) � ! <br /> P T <br /> PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A fr. t fti"a lr f <br /> I N ° S. <br /> E <br /> L , <br /> D gEXCAVATION SIZE: iX fS�' X '� YDS OF SOIL: <br /> : <br /> 1� ds <br /> I ADEPTH 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 YDS OF SOIL <br /> z <br /> 0H DEPTH TO G.W. : <br /> N 2 _ FT SAMPLING METHOD <br /> 00 p OF HOURS SINCE DEWATERING; <br /> EO f OTHER SAMPLE: <br /> LLL 111 7r6 � � y5 � Li <br /> i <br /> LABORATORY: ,'A ehA r, SAMPLERS NAME:— <br /> CLOSURE <br /> AME;CLOSURE IN PLACEMIXTURE: VOLUME: <br /> err[ 2'! DRAW SITE MAP ON REVERSE <br />