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SJLHD — UN GROUND 'TANK CLOSURE/A1)AN L•'N'1' INSYL••CY'1UN <br /> (SHADED A� TO BE FILLED IN FOR THE .ZRST TANK ONLY) <br /> z <br /> G OWNER NAME OWNER PHONE I <br /> N s CONTRACTOR CON. PHONEI <br /> E Cris <br /> Ce.�5ru <br /> R S <br /> A JLH PERMIT I 7 EPA FIRE PERMIT I /7i L/1 <br /> INSPECTOR &7, C,), DATE TANK I 39 — _2S _ _ f— <br /> R RINSED / ) METHODRINSE AMOUNT <br /> I �Tr. /P/ rn9 CGS <br /> N RINSATE DISPOSAL SITE Y <br /> S <br /> E MANIFEST I —OR— OTHER <br /> V VAPORS PURGED Y/ ) METHOD <br /> A �L - �� AMOUNT USED <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, IBERGLASS, OTHER) TANK SIZE <br /> K C SUO <br /> / O TANK CONDITION (GOOD, POOR HOC <br /> P N <br /> I S PIPE MATERIAL STEW , FIBERGLASS, OTHER) I FEET <br /> P T <br /> I PIPING CONDITION OL <br /> (GOOD, POOR, ES) <br /> N [�T <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE I <br /> F A <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE:. X ! X r <br /> g- YDS OF SOIL : <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE I <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X <br /> I I YDS OF SOIL ('al Ids <br /> O H DEPTH TO C.W. : <br /> N 2 FT SAMPLING METHOD _ <br /> 0 I OF HOURS SINCE DEWATERING: <br /> 00 OTHER SAMPLE: <br /> �LJJABORATORY: <br /> SAMPLERS NAME: 1/'M ,X" <br /> CLOSURE IN PLACE MIXTURE <br /> VOLUME: <br /> DRAW SITE MAP <br /> 1{1( 2:1 04:1(7/$$) ON R'EVERSEJ <br />