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_ SJLHD - UNDE;_-, <br /> ' r'�UUND 'TANK CLOSURE/AfU►NDO 'NT I N;;1'LCT 1 UN <br /> ' (SHADED ARETO DE FILLED IN <br /> FO <br /> e R THE Fi~T TANK ONLY) F <br /> o1v e, <br /> G OWNER NAME OWNER PHONE T f <br /> N CONTRACTOR CON. PHONE q <br /> R t SJLHD PERMIT I EPA I �s RE PERMIT 0 <br /> L . � ' <br /> INSPECTOR DATE TANK l j� 39 -- -lr-fz - / <br /> R RINSED (YIN) METHOD k RINSE AMOUNT <br /> f - I <br /> N RINSATE DISPOSAL SITE I M <br /> S I I� <br /># E MANIF9ST <br /> -OR [! OTHER <br /> V VAPORS PURGED (Y/N) METHODI/�t �� <br /> -A <br /> + AMOUNT USED <br /> PL.E.L.. READING AT REMOVAL (MUST BE C 20%�) <br /> T R COMMENTS f <br /> N TANK MATERIAL (STEL, FIBERGLASS OTHER)I TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES) j <br /> P N it <br /> ` I S PIPE MATERIA (STEEL, FIBERGLASS, 0 `!HER)ij FEET ? <br /> J P T <br /> I PIPING CONDITI GOOD, POOR, HOLES) <br /> N <br /> I <br /> G DEPTH SOIL TYPE OBSERVATION I� SAMPLE 9 <br /> T <br /> fIrl <br /> E K i iM <br /> L i ip <br /> D ! <br /> S-. .�EXCAVATION SIZE: D..,. X Z-1 X [I iYDS OF SOIL: /3G yd s��� � <br /> I A DEPTH SOIL TYPE OBSERVATION f N SAMPLE Itk <br /> N M P <br /> S P I <br /> P L P !i _I <br /> E I- <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I �F <br /> 0 H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 -�'�"- �� iM } <br /> 0 I OF HOURS SINCE DEWATERING: I I <br /> aOTHER SAMPLE: I� <br /> i <br /> LABORATORY: ul, SAMPLERS NAM I <br /> CLOSURE IN PLACE MIXTURE: '� VOLUME: r <br /> I <br /> DRAW SITE MAP ON REVERSE <br /> E f 23 04:1(7/$$) e <br />