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SJLHD - UNDERGROUND 'TANK CLOSURE/AlLANDONMEN`2' I N!a%cg1 I UN <br /> (SIlADED AREA TO BE FILLED IN FOR TILE FIRST <br /> La <br /> � , =. � - <br /> E . ` OWNER NAME LtA /q�o/+�,�'' OWNER PHONE I <br /> N c CONTRACTOR <br /> E : Gam//�Or� =Alzzllv?flq CON. PHONEN - <br /> 7,2—le f f i< <br /> R t SJLHD PERMIT I EPA I <br /> A FIRE PERMIT 9 <br /> INSP C <br /> CuU�-c- DATE//- 7_ 1 TANK <br /> R RINSED /N) METHOD / a <br /> I ;l e-s. RINSE AMOUNT © <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFRST II <br /> - -OR- OTHER <br /> V VAPORS PURGED Y/N) METHOD <br /> A AMOUNT USED,,: <br /> P L.E.L. READING AT REMOVAL (MUST BE < 201) <br /> 0 <br /> T R COMMENTS <br /> _ u <br /> A - .at +� �.. �.,�e� - Ir <br /> N TANK MATERIAL (STEEL, FIBERGLASSr�' pTHER) TANK SIZE <br /> / 0 TANK CONDITION (Coop; POOR, HOLES) !� <br /> P N _ �RoK �k ;A f� whifc <br /> I S PIPE MATERIAL (STEED) FIBERGLASS, OTHER) FEET ��K0 V rn <br /> P T • <br /> I <br /> N PIPING CONDITION (GOOD, POOR, HOLES) <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE <br /> F AAk <br /> ;i. f <br /> I N <br /> E K I f ✓ � <br /> L <br /> D EXCAVATION SIZE: { X <br /> S. X YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE p <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 /> 0 H DEPTH TO C.N. : <br /> N 2 ------ FT SAMPLING METHOD <br /> 0 1 OF HOURS SINCE DEWATERING: <br /> E 0 OTHER SAMPLE: <br /> j LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br /> >rr •,• i DRA W C Tery W. ., os <br />