Laserfiche WebLink
r SJLHD - U 'GROUND 'DANK CLOSURE/WN "MENT INSNEC'1'IUN <br /> (SHADED 1 TO BE FILLED IN FOR �'NE ?ST TANK ONLY) <br /> vsff" - <br /> +h <br /> G OWNER NAME OWNER PHONE I <br /> E go a rf �D q "6 3S s t 4� <br /> N j CONTRACTOR OUA�_ CON. PHONE N �o °j q q z (e l )i{ <br /> E . ; <br /> R SJLHD PERMIT 1 EPA 1 FIRE PERMIT M <br /> L t • ,, <br /> INSPECTOR �� X- DATE DL X?lTANK t 39 <br /> R RINSED (Y/N) METHOD -Tr,- /C RINSE AMOUNT a- S c <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST I -OR- OTHER <br /> V VAPORS PURGEDY N) METHOD D ^� AMOUNT USED 16/1 <br /> .A <br /> .PO G.E.L. READING AT REMOVAL (MUST BE'< 201) 35 3vj6 C, v/ <br /> T R COMMENTS Z�lP. a hd� "?--r� R rc... D <br /> A <br /> N TANK MATERIAL -STEEL IBER(;LASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD, OOR HOLES) <br /> P N <br /> I S PIPE MATERIAL. STE , FIBERGLASS, OTHER I FEET <br /> p T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G <br /> T DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> F A p <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: X X ,L YDS OF SOIL: <br /> 3- <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 C TRENCH DIMENSION X — X YDS OF SOIL <br /> I <br /> _ O 2 H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N <br /> 0 1 OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY:C O LRS NAME: Don 6m•u, <br /> CLOSURE IN PLACE MIXTURE:L. VOLUME: <br /> DRAW SITR MAP ON REVERSE <br />