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SJLHD - UNDF -ROUND TANK CLOS'URL/JIVNDO '.NT 114 L;P ECTI 0 14 <br /> (SHADED ARE TO BE FILLED IN FOR THE F. JT TANK ONLY) <br /> =It <br /> G 5 <br /> OWNER NAME OWNER PHONE <br /> 7vuo-70 e� <br /> E '7 <br /> N CONTRACTOR <br /> E CON . PHONE -70 <br /> R SJLHD PERMIT EPA # FIRE PERMIT 4 <br /> A . . . . . . .. . . . . . . . . . . . . . . <br /> 4041f IN <br /> L R Off <br /> L <br /> INSPECTOR j1 DATE TANK 0 39 <br /> R RINSED METHOD j RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> 1044 <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED ,,CYN) METHOD -7, _—FAMOUNT USED <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 201t) <br /> 0 <br /> T R COMMENTS <br /> .1�' FIBERGLASS, OTHER) SIZE <br /> N TANK MATERiAL ( ST�L TANK <br /> K C <br /> 0 TANK CONDITION (GOODe-POOR4 HOLES) <br /> P N <br /> I S PIPE MATERIALi ST FIBERGLASS, OTHER) U FEET <br /> P T <br /> I PIPING CONDITION (GOOD, PO HOLES ) <br /> N " �_R) <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE It <br /> T <br /> F A we,✓ 11e-Aaj A13 <br /> I N Z <br /> E K <br /> L <br /> D EXCAVATION SIZE: X X YDS OF SOIL : <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> N M P <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 G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 q OF HOURS SINCE DEWATERING: <br /> OTHER SAMPLE: <br /> H <br /> FOE- <br /> LABORATORY: --- <br /> SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE HAP ON REVl-RSr-,' <br />