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SJL 14D -- UNDOUROUND 'TANK C:LOII;URE/ JiL�ANDW-11 r 11gL;YE;cTl ulq <br /> (SHADED AREA TO BE FILLRED IN FOR THE FIRST TANK ONLY) <br /> " 'm <br /> G OWNEt-NAME ISE OWNER PHONE P a5 4&3- 38.2 ill <br /> 22 <br /> �. <br /> E <br /> E i CONTRACTOR CDtis T CON. PHONE / 12!� <br /> R SJLHD PERMIT II EPA II CAOCI�! (o()" ETRE PERMIT A <br /> INSPECTOR FA VIL DATE _ _ TANK 1 39 <br /> R RINSED L4 N) METHOD �` RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST ISS 3S 1{0 -OR- OTHERJ <br /> V VAPORS PURGED ON) METHOD bk'T� I c! AMOUNT USED I& /b-s <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE 4 20'x) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL EEL FIBERGLASS, OTHER) TANK SIZE <br /> K C L 1 00 o <br /> / 0 TANK CONDITIONGOOD POOR, HOLES) +l,+r <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET .., ` <br /> P T to <br /> I PIPING CONDITION (GOOD, POOR, HOLES ) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION d�©CC) �C D SAMPLE I) <br /> T <br /> F A ? C�,,,1• :.c fo�.'r nom+ r. x,. . �.! <br /> I N � v t t r Gti n • IN S <br /> E K <br /> L <br /> D EXCAVATION SIZE: X , yy( X YDS OF SOIL: 53 <br /> S- <br /> r A DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> N M P <br /> S P I _' cvz , fir<� .c{:-c.4a7w e�_ +.� f•.T�, 5 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 G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 70 � <br /> 0 Y OF HOURS SINCE DEWATERING: <br /> d OTHER SAMPLE: <br /> LABORATORY: u©� SAMPLERS NAME: tAsk-e. or <br /> CLOSURE IN PLACE MIXTURE: Ey-OLUME: <br /> DRAW SITE MIIP ON REVERSE <br /> Ell 2:1 01:10/810 <br />