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ill <br /> SJLHD — UNf "'f OUND TANK CLOSURVA'lu1ND:l NT INSL'L•ci,iuN p, ✓ <br /> (SHADED AL1 TO BE FILLED 'IN FOR k!TffE 1caT TANK ONLY) f <br /> 1- 11MIR ZT, <br /> HN,11.1" <br /> rU / /�/✓G S s ,�/�,2S <br /> II <br /> JrR <br /> OWNER NAME f�� S' N� OWNER{ PHONE A <br /> 335 <br /> 4, CONTRACTOR � � . CON. PHONE l . <br /> SJLHD PERMIT 1 E Poor 6 FIRE PERMIT 0 <br /> 11 <br /> E INSPECTOR DATE Fll f TANK `Y 39 — � r <br /> R RINSED (Y N) METHOD, RINSE AMOUNT, <br /> I <br /> N RINSATE DISPOSAL SITE it <br /> E MANIFEST # —0-R— ,OTHER <br /> _.. - .a <br /> V VAPORS PURGED (11N) METHOD °G AMOUNT USED <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 2;6%) <br /> 0 t k <br /> T L R COMMENTS <br /> A <br /> N TALK MATERIALSTEEL, FIBERGLASS, OTHER) TANK SIZE p <br /> K C <br /> / 0 TANK CONDITION (GOOD POOR, HOLES ' <br /> P N <br /> ILT PIPE MATERIAL ��TEE , FIBERGLASS, 'OTHE,R) FEET <br /> P IPIPING CONDITIO (GOOD, POOR, HOLES) <br /> N � <br /> G DEPTH SOIL TYPE OBSERVATIONL AMPLE # <br /> T <br /> F A <br /> I N i } <br /> E K I M <br /> L IL i <br /> D EXCAVATION SIZE: X'r X '� ,I <br /> YDS OF SOIL: Z { <br /> s- <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE If <br /> N M Pt <br /> S P I :F 6 i <br /> P L P " I <br /> E I. E <br /> C N It o <br /> T G TRENCH DIMENSION X-t X YDS OF SOIL <br /> I <br /> 0 H DEPTH TO C.W. : FTSAMPLING METHOD <br /> N 2 <br /> 0 Y OF HOURS SINCE DEWATERING: <br /> 0OTHER SAMPLE: <br /> LABORATORY: /iv� �— i SAMPLERS NAME <br /> ..J <br /> CLOSURE IN PLACE MIXTURE: p i VOLUME: <br /> DRAW SITE MAP ON REVERSE ' <br /> Ill 23 043(7/88) <br />