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SJLHDRGROUND TANK CLOSURE/ALIAONMENT I.N:il- LC TI UN <br />(SHADEDA TO HE FILLED IN FOR THE FIRST TUNIC ONLY) <br />"'� "' ••i •„ate �, 11V Wil. 1•, J.] .� 1.1 1 I j <br />/S i/: <br />G OWNER NAME ��rD OWNER PHONE 9 `ll� 1 f//}}. <br />E <br />N CONTRACTOR Lt�al��Gl� / CON. PHONEq <br />E <br />R ` SJLH PERMIT IEPA IC1,4eXo/7na6 FIRE PERMIT 9 <br />L ... ...... I ........ ... �`=; <br />Hit <br />INSPECTOR �L DATE-�,�-�� TANK a 39 -- /,-X 6, - wD <br />R RINSED (ON) METHOD �i'/45540t i-00 RINSE AMOUNT /. <br />I c: <br />N RINSATE DISPOSAL SITE�PtZ f,•�-cps jf Sac. <br />� <br />S _ y c%, <br />E MANIFEST I _ -OR- OTHER YCCierft # n7Q� <br />V VAPORS PURGED (VN) METHODdlooc, e -=AMOUNT USED <br />A <br />.P L.E.L. READING AT REMOVAL (MUST BE C 20%) <br />0 <br />T R COMMENTS <br />A <br />N TANK MATERIAL STEEL FIBERGLASS, OTHER) FTANK SIZE <br />K C <br />/ 0 TANK CONDITION (GOOD• POOR, HOLES) <br />P N <br />I S PIPE MATERIA STEE , FIBERGLASS, OTHER) FEET D r <br />P T <br />I PIPING CONDITION(GOOD POOR, HOLES) <br />N <br />G T DEPTH SOIL TYPE OBSERVATION SAMPLE 0 <br />F A <br />I N <br />E K <br />L <br />D EXCAVATION SIZE: �, X ,�, X YDS OF SOIL. <br />s: <br />I A DEPTH SOIL TYPE OBSERVATION SAMPLE <br />N M P <br />S P I <br />P L P <br />E I E <br />+C N <br />T G TRENCH DIMENSION X X <br />YDS OF SOIL <br />I ' <br />0 H DEPTH TO G.W.:� FT SAMPLING METHOD <br />N 2 <br />ED <br />0 1 OF HOURS SINCE DEWATERING: <br />THER SAMPLE: <br />LABORATORY : 0Ce no'gli- SAMPLERS NAME: <br />CLOSURE IN PLACE MIXTURE:. VOLUME: <br />I'll 2:1 01.1(7I88) DRAW SITE MAP ON 9EVERSf, <br />