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SJLHD - UNDP��GROUND TANK CLOSURE/A4ANDf' `ENT INS1'El;!'lUN <br /> (SHADED Ar TO BE FILLED IN FOR THE MAST TANK ONL y) <br /> G : OWNER NAME OWNER PHONE ' <br /> E i Ca f T/z� # <br /> ave, -moi yy-S 7/ <br /> N CONTRACTOR CON. PHONE# <br /> E /ro G/l /i�c. <br /> R 4 SJLHD , ERMIT # EPA I <br /> A FIRE PERMIT <br /> INSPECTOR DATE j0//Ul � TANK @ 39 - _ /Uy 7 <br /> f <br /> R RINSED Y N) METHOD <br /> I RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> ' E HE <br /> T # -OR- OTHER <br /> V VAPORS PURGED Y(�N) METHOD �yy /� e <br /> A AMOUNT USED <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) QC2/ <br /> O <br /> T R COMMENTS <br /> A <br /> NF <br /> TANK MATERIAL STEEL FIBERGLASS, OTHER) TANK SIZE <br /> K /o O v v <br /> / TANK CONDITION GOOD, POOR, HOLES) <br /> P <br /> I S PIPE MATERIAL STEE , FIBERGLASS, OTHER) # FEET <br /> '`P T S- <br /> I PIPING CONDITION , —00 , POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: XIX a ' YDS OF SOIL: <br /> S-: - BOO y ds <br /> I A PTH SOIL TYPE ,OERVATION <br /> N M P SAMPLE # <br /> � <br /> S P 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 C.W. : FT SAMPLING METHOD <br /> N 2 h� <br /> 0 1 OF HOURS SINCE DEWATERING: <br /> 107 OTHER SAMPLE: (f' -J <br /> i <br /> LABORATORY: <br /> SAL7�NA =E: 7�7e"TcT]3(-rC711L <br /> CLOSURE IN PLA <br /> VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />