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SJLHD - UNDEP "ROUND YANK CLOSURI1 /A1JAND(3 -_ :N'1' IN:;i'LL'i'lUN <br /> (SHADED ARE" 1'O BE FILLED IN FOR TUE Fi �'T TANK ONLY) <br /> � lip . .. . . . <br /> e All <br /> G OWNER NAME OWNER,l// PHONE # <br /> E USG!'_ �a, <br /> N CONTRACTOR __�571GQ CON. PHONE Af' v <br /> �-- shy G S 3 <br /> R SJLHD PERMIT I EPA # li FIRE PERMIT # 1,7_,S-7'1?A <br /> k <br />�. INSPECTORS/ DATE TANK .# 1� 39 - <br /> R RINSED (Y/N} METHOD I RINSE AMOUNT 4 <br /> Ii <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR'! OTHER <br /> V VAPORS PURGED (YIN M1� J_ <br /> ETHOD �� it AMOUNT USED /Sr �000 <br /> A 3 <br /> •P L.E.L. READING AT REMOVAL (MUST BE Ci 20%1�) <br /> 0 �; F <br /> T R COMMENTS <br /> A <br />� f <br /> N TANK MATERIAL (STEEL FIBERGLASS, OTHER) N TANK SIZE <br /> K C <br /> / 0 TANK CONDITION GOOD POOR, HOLES) <br /> P N <br /> I S PIPE MATERIAL SSLTEEL'�FIBERGLASS, OTHER) �� # FEET <br /> P T ' <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> GT DEPTH SOIL TYPE OBSERVATION , AeF �/�a�cc��� SAMPLE # <br /> F ABEE ? ✓� Lv�. r i <br /> I N 0 1 .i1 <br /> E <br /> L I l <br /> D EXCAVATION SIZE: . D X X 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 1 M <br /> E I E <br /> C N �] ! <br /> T G TRENCH DIMENSION X X [ YDS OF SOIL <br /> I . u <br /> O H DEPTH TO C.W. : _ FT SAMPLING METHOD <br /> N 2 <br /> 0 11 OF HOURS SINCE DEWATERING: i I� <br /> O OTHER SAMPLE_E : <br /> LABORATORY: c�L iISAMP'LERS NAME: ' <br /> i <br /> LL <br /> CLOSURE IN PLACE MIXTURE: I VOLUME: <br /> t l <br /> DRAW SITE HAp ON REVERSE :' �. <br /> 1?1I 23 04:1(7/88) <br />