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SJLHD - UNDF OUND 'DANK CLOSUrig/AIUANDO AT 6 0 <br /> 1.(SHADED ARLle-ilo BE FILLED INSI'L�%•1't ) � <br /> e IN FOR TIIE FIi�ST TANK ONLY) <br /> G i <br /> E ,._ <br /> I 6S v r7e04NER NA X0012�. OWNER <br /> s <br /> PHONE I c, ' <br /> N � CONTRACTQR 2-o <br /> .� <br /> /r/S//x'('t C CON. FHONEk • <br /> R SJLHD PERMIT 1 EFA (� <br /> j L <br /> �'� INSPECT T'� <br /> mmpc <br /> DATE 9 TANK M 3 9 - _ `j <br /> R RINSED ( N) i` <br /> I METHOD<--- RINSE MOUNT/ <br /> N RINSATE DISPOSAL SITE <br /> S " <br /> E MANIFRST 1 <br /> - -OR- OTHER <br /> V VAPORS PURGED Y N) METHOD <br /> A 1RI AMOUNT USED <br /> .P L.E.L. READING AT REMOVAL (MUST BE t 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEE , FIBERGLASS, OTHER} TANK SIZE <br /> K C <br /> / 0 TANK CONDITION GOOD, POOR, BOLES) 1 <br /> P N <br /> I S PIPE MATERIAL (STEE BERGLASS, OTHER) FEET �/--LL <br /> P T T <br /> I PIPING CONDITION (GOOD POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE 1 <br /> r N n-z_- <br /> E K <br /> L <br /> D EXCAVATION SIZE: _Z X ? X <br /> S; ____ YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE 1 <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION ^„� X �_ X <br /> I �_ <br /> YDS OF SOIL <br /> 0 H DEPTH TO G.H. ; FT <br /> N 2 SAMPLING METHOD <br /> 0 1 OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> J LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br /> l;i[ 2:1 OSI:1(7/$f3) GRAN SITE HAP ON REVERSE <br />,• <br />