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SJLHD -- UN {GROUND 'TANK CLOSURE/Al�ANDW N'T INSLILCTIUN <br />(SHADED A TO BE FILLED IN FOR THE ST TANK ONLY) <br />IN 111 <br />G OWNER NAME �Vrd OWNER PHONE '-/6,_3/ 7'-/6,�/ <br />E �*r» u <br />N c COHTRACTO CON. PHONEY Q8� <br />E <br />R c SJLHD ERMIT I EPA lC,4Coaof70a6 FIRE PERMIT ?dW <br />{�= <br />INSPECTOR �`per DATE TANK Y 39 - S - 0/ <br />R RINSED ' t N) METHOD 0-9S5a-e RINSE AMOUNT <br />I <br />�' o Sar. <br />N RINSATE DISPOSAL SITE X)a <br />/mos �/ c yc/�2 tsi.�- 5�s rPru�s <br />S <br />E MANIFEST I -OR- OTHER re e f C---077! <br />V VAPORS PURGED (N) METHOD ��Y /� 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 !0/Qt�tJ ct/ <br />K C <br />/ 0 TANK CONDITION (GOOD POOR, HOLES) <br />P N <br />I S PIPE MATERIA STEE', FIBERGLASS, OTHER) FEET q0 i <br />'P T <br />I PIPING CONDITION (GOOD POOR, HOLES) <br />N <br />G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />T <br />I N C <br />E K <br />L <br />D EXCAVATION SIZE: 1 X X - Zaz YDS OF SOIL: goo <br />s- <br />I A DEPTH SOIL TYPE OBSERVATION SAMPLE <br />N M P <br />S P I 41, <br />� r <br />Zwo <br />E I E <br />-5 <br />C N ' .r ., !r <br />�. <br />T G TRENCH DIMENSION _Z/�r X _,2.�/j'X 3' YDS OF SOIL r/5 <br />I ' <br />0 H DEPTH TO C.W.: FT SAMPLING METHOD <br />N 2 <br />0 1 OF HOURS SINCE DEWATERING: <br />ELOTHER SAMPLE: <br />LABORATORY: ( �,/�s _ SAMPLERS NAME: <br />i <br />CLOSURE IN PLACE I MIXTURE VOLUME: <br />DRAW SITE MAP ON REVERSE <br />I'll 23 04:1(7/88) <br />