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SJLHD - L*RGRUUND 'TANK CLOSURE/A4AONMENT 1N5YECTI UN <br />(SHADED AREA TO DE FILLED IN FOR THE FIRST TANK ONLY) <br />�7idd7ie'�1tD[tI:5777�?iC'Yit?L7 <br />Ama �ir7r -S7fLc L e �/M <br />iS r.� <br />I S �.N L n <br />G <br />E <br />;OWNER NAME �i✓Gro G, um a <br />,p.%CD <br />OWNER PHONE `/lv `/_3/ �/ <br />N <br />E <br />< CONTRACTOR <br />' <br />CON. PHONE# <br />R <br />< SJLH PERMIT I EPA NcVC6190170a6 FIRE PERMIT # <br />RHIN <br />INSPECTOR <br />DATE rp-/�-�y <br />TANK I 39 - /d16,S- <br />R <br />RINSED 04) METHOD IP1455lC�C a��aLt1 RINSE AMOUNT <br />N <br />S <br />�PtL Sac <br />RINSATE DISPOSAL SITE��y� /r��, <br />/mos �S�s V4 L vs� <br />E <br />MANIFEST # �_ -OR- OTHER recievt # 00077 <br />V <br />A <br />VAPORS PURGED (g>N ) <br />METHOD dj Y /�e <br />AMOUNT USED <br />L.E.L. READING AT REMOVAL (MUST BE < 20%) <br />P <br />0 <br />COMMENTS <br />T <br />R <br />A <br />N <br />K <br />C <br />TANK MATERIAL STEEL FIBERGLASS, OTHER) <br />TANK SIZE Si yp O ti� <br />/ <br />P <br />0 <br />N <br />TANK CONDITION (G0 POOR, HOLES) <br />PIPE MATERIA STEE , FIBERGLASS, OTHER) <br />I FEET 7 O <br />I <br />"P <br />S <br />T <br />PIPING CONDITION (GOOD POOR, HOLES) <br />I <br />N <br />G <br />T <br />DEPTH SOIL TYPE <br />OBSERVATION <br />SAMPLE I <br />F <br />A <br />' Sand <br />i.On vi t <br />l>7 its <br />I <br />N <br />E <br />K <br />L <br />D <br />3: <br />EXCAVATION SIZE: _'iL X 2z X _zz <br />YDS OF SOIL: O <br />I <br />N <br />A <br />M <br />P <br />DEPTH <br />SOIL TYPE <br />OBSERVATION <br />SAMPLE # <br />S <br />P <br />I <br />P <br />L <br />P <br />E <br />I <br />E <br />C <br />N <br />T <br />I <br />0 <br />N <br />G <br />H <br />2 <br />TRENCH DIMENSION X X YDS OF SOIL <br />' '_ <br />DEPTH TO C.W.: FT SAMPLING METHOD <br />0 <br />I OF HOURS SINCE DEWATERING: <br />❑O <br />OTHER SAMPLE: <br />LABORATORY: �crno�ie �Gr%lS - <br />SAMPLERS NAME: <br />CLOSURE IN PLACE MIXTURE: <br />VOLUME: <br />Ell 2:1 01:1(7/88) <br />DRAW SITE. MAP ON YEVERSI; <br />