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f SULHD — UNDE`_ OUND 'TANK CLOSUkE/AJV, NDOP Jr AT I N:; J : <br /> f.911ADED AREyl✓i'0 BE FILLED t Lc.► uN y <br /> tN FOR TlLC FI'7! ?' TANK ONL Y) 0 ] <br /> o <br /> E OWNER NAME OWNER PHONE <br /> U <br /> N CONTRACTOR <f CON. PHONED <br /> R a SJLHD PERMIT 1 EPA D <br /> FIRE PERMIT D M7��- �� <br /> INSPEC OR DATE 9 TANK M 39 <br /> R RINSEDY <br /> I ) METHOD tN� RINSE AMOUNT �M <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIF&ST --OR-- OTHER <br /> V VAPORS PURGED Y N) METHOD <br /> A Dg\ �GF AMOUNT USED <br /> •P L.E.G. READING AT REMOVAL (MUST BE < 203) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL TE FIBERGLASS, OTHER) TANK SIZE <br /> K C � <br /> / 0 TANK CONDITION (GOOD POOR, HOLES) <br /> P N <br /> I S PIPE MAITERIAL (STEEL, FIBERGLASS, OTHER) 1 FEET <br /> P T <br /> I PIPING CONDITIO GOOD 0� POOR, HOLES) <br /> N <br /> G I TH SOIL TYPE OBSERVATION <br /> T SAMPLE D <br /> F A <br /> I N ! ` <br /> E K <br /> L <br /> D EXCAVATION SIZE: ? X X YDS OF SOIL: <br /> S; <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE D <br /> S P I <br /> P L P <br /> E I' E <br /> C N <br /> T G TRENCH DIMENSION __ X X <br /> I YDS OF SOIL <br /> O H DEPTH TO C.W. : FT <br /> N 2 SAMPLING METHOD <br /> 0 f OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> J LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br /> ):If <br /> DRAW SITE <br /> 2;1 01:1(7/$$) NAP ON REVERSE <br />