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39—/Z9?-/ (O llFD/3) <br /> SJLHD - UNDL•'I ROUND 'TANK CLOSURL/A1(ANDO NT INSL'LGIlUN <br /> (SHADED AREJ'O BE FILLED IN FOR THE F T TANK ONLY) <br /> G OWNER NAME -'Al X572/ OWNER PHONE 1 QG�` y6 �� �iGld <br /> E � U <br /> N CONTRACTOR � CON. PH0NEM ' <br /> E <br /> R t SJLHD PERMIT tlEPA tl FIRE PERMIT <br /> L . jWMU <br /> INSPECTOR `// DATE/ TANK Y 39 <br /> R RINSED (Y/N) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST tl -OR- OTHER <br /> T— <br /> N <br /> VAPORS PURGED (Y/N) METHOD � AMOUNT USED <br /> L.E.L. READING AT REMOVAL (MUST BE < 208) <br /> T COMMENTS <br /> A <br /> TANK MATERIAL TEEL FIBERGLASS, OTHER) TANK SIZE ` s <br /> K Ca�O a <br /> / 0 TANK CONDITION (GOOD POOR, HOLES) <br /> P N <br /> I S PIPE MATERIAL (STEELO FIBERGLASS, OTHER) tl FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES ) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> T <br /> F A <br /> I N <br /> E K Z <br /> KIWI- <br /> LI / <br /> D EXCAVATION SIZE: X0 X YDS OF SOIL: <br /> s: <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE I <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 YDS OF SOIL <br /> I <br /> 0 H DEPTH TO C.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 1 OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: <br /> LABORATORY: CAl, LA SAMPLERS NAME: <br /> i <br /> LLF <br /> CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> ]:I( 2:1 04:1(7/88)R) DRAW SITE MAP ON REVERSE <br />