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SJLHD - UND "' UND TANK CLOSURE/AUND 1' IIJ:;PECTlUN <br /> (SHADED ARjpmr0 DE FILLED IN FOR THE TANK ONLY) <br /> G < OWNERNAME � _ OWNER PHONE q <br /> E <br /> N CONTRACTOR (�(�a fhli(/ S CON . PHONE# <br /> E <br /> R < SJLHD PERMIT q EPA # FIRE PERMIT # <br /> L <br /> INSPECTOR ke DATE J JA, fg TANK q 39 <br /> R RINSED (YN) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y N) METHOD AMOUNT USED <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST a, < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL 5rLLL t'It1L•UGLASS, 0'1'HER) TANK SIZEIa 1 / <br /> K C <br /> / 0 TANK CONDITIO600 , POOR, I1OLES) LGO i /1�/7c ` � <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) q FEET <br /> P T <br /> I PIPING CONDITION GOOD, POOR, HOLES ) 5 pSf <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION S MPLE # <br /> T <br /> F A <br /> I N <br /> E K CtM a <br /> L <br /> D EXCAVATION SIZE: XX 71 YDS OF SOIL : <br /> 11 LS <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE q <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 /> 0moDEPTH TO C.W. : FT SAMPLING METHOD <br /> N I OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE. <br /> !lf '?3 043(7/88) <br />