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SJLHD - UND (OUND 'TANK CLOSURE/AltiANDO NT I Ns i:CT1ON <br /> (SHADED ARL•. TO BE FILLED IN FOR THE AT TANK ONLY) <br /> � . . . IN, gf T om . <br /> G OWNER NAME 7 OWNER PHONE N <�, <br /> E i CONTRACTOR CON. PHONEN <br /> R < SJLHD PERMIT 11 EPA FIRE PERMIT <br /> L � CLOSURE � � <br /> INSPECTOR �� jj�- DATE ��� ��7 TANK Y 39 <br /> R RINSED (Y )� N1 _METHOD _ RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE ' L�c%� u'r.� �: ✓�'' S <br /> S <br /> E MANIFEST @ — -OR- OTHER <br /> V VAPORS PURGED (Y ) MEgHOD, � AMOUNT USED /, 1 <br /> A _ 11 <br /> P L.E.L. READING AT REMOVAL (MUST BE < 208) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL, ( STEEL FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION 0 D, POOR, HOLES) <br /> P N <br /> I S PIPE MATERIAL 6fkEFIBERGLASS, OTHER) # FEET <br /> I PIPING CONDITION�GOODf POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE q <br /> F A l % �, inn �nC Y✓ :�.i i9 ,:n <br /> I N - <br /> E K our.* /-),i <br /> Lfi�s�_ _or -, <br /> D EXCAVATION SIZE: X X 1 YDS OF SOIL: <br /> S- <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE I <br /> N M P <br /> S P I "l'. �r1 L'Y•- l_ s'W ; S, cs'-.�,, i l 77bT, <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> O H DEPTH TO G.W. : LL;44 ,, *tie`FT SAMPLING METHOD <br /> N 2 <br /> 0 A OF HOURS SINCE DEWATERING: <br /> LF-01 <br /> OTHER SAMPLE: <br /> LABORATORY: � '�� �i�p SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: —— VOLUME:- <br /> DRAW SITE MAP ON REVERSE <br /> )?N 2:1 043(7/88) <br />