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SJLHD - UND1 ',ROUND 'TANK CLOSURE/AI�ANDO"'ENT IN-SVECTIUN <br />( SHADED ARL -sr TO BE FILLED IM FOR THE F...eST TANK ONLY) <br />G OWNER NAMEC�G OWNER PHONE # 333 -elr <br />r <br />N CONTRACTOR <br />?Gr / CON. PHONE# <br />E <br />R < SJLHD PERMIT V EPA # FIRE PERMIT N <br />A WPM <br />T I R <br />A <br />N <br />K C <br />/ 0 <br />P N <br />I S <br />P T <br />I <br />N <br />G <br />F <br />I <br />E <br />L <br />D <br />S <br />I A <br />N M <br />S P <br />P L <br />E I <br />C N <br />T G <br />I <br />O <br />N <br />NSPECTOR �+�I-ees ��� DATE � 1 TANK 0 39 - - <br />c, <br />RINSED (Y/Tfj METHOD RINSE AMOUNT <br />RINSATE DISPOSAL SITE <br />MANIFEST ff -OR- OTHER <br />VAPORS PURGED ((x/N) METHOD OeV JCtAMOUNT USED 2ff <br />L.E.L. READING AT REMOVAL (MUST BE < 20%) <br />COMMENTS <br />TANK MATERIAL\(�TEEL, IBERGLASS, OTHER) TANK SIZE <br />TANK CONDITION (GOOD, POOR, HOLES) <br />PIPE MATERIAL (STEEL, FIBERGLASS, OTF{ER) # FEET <br />PIPING CONDITION (GOOD, POOR, HOLES) <br />DEPTH SOIL TYPE OBSERVATION SAMPLE A <br />T <br />/ L. <br />A <br />N 'urhf..,-h I <br />• <br />*v oerx 2 <br />1. 4- <br />CAVATION SIZE: X X YDS OF SOIL: <br />LABORATORY: + <br />SAMPLERS NAME: <br />CLOSURE IN PLACE I MIXTURE: I VOLUME: <br />_L—DRAW SITE MAP ON REVERSE <br />EH ?3 043(7/88) <br />DEPTH SOIL TYPE <br />OBSERVATION <br />SAMPLE # <br />I <br />P <br />E <br />TRENCH DIMENSION <br />X X <br />YDS <br />OF SOIL <br />H <br />2 <br />DEPTH TO G.W.: FT <br />SAMPLING <br />METHOD <br />0 <br /># OF HOURS SINCE <br />DEWATERING: <br />F 7o <br />OTHER SAMPLE: <br />LABORATORY: + <br />SAMPLERS NAME: <br />CLOSURE IN PLACE I MIXTURE: I VOLUME: <br />_L—DRAW SITE MAP ON REVERSE <br />EH ?3 043(7/88) <br />