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SJLHD — UNDERGROUND 'TANK CLOSURE/A!)ANDONML•'NT 1NSYl;C'1'lUN <br /> (SHADED AREA TO DF. FILLED IN FOR TNL•' FIRST TANK ONLY) <br /> 110Two <br /> 1 <br /> nr/Ps Seo fel 3C N, Crrii9t1.5t F/cro <br /> O OWNER NAME OWNER PHONE 1 <br /> J(a&17 ' <br /> N COYTRACTOR CON. PHONEN ' <br /> F <br /> R SJLH PERMIT 1 EPA N FIRE PERMIT N <br /> 1�la vv <br /> INSPECTOR z_ DATE S�aS�/v TANK 1 39 - ILdoZ - _ <br /> R RINSED �( Y/N) METHOD �� RINSE AMOUNT /� <br /> I <br /> S RINSATE DISPOSAL SITE <br /> F <br /> E MANInST 1 -OR- OTHER <br /> VVAPORS PURGED (,yjN) METHOD j�) ;�� AMOUNT USED <br /> P L.E.L. READING AT REMOVAL (MUST BE C 20% ) <br /> O <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL fMELoJFIBERGLASS� OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOODt POORo HOLES) ) <br /> P N �__—-- <br /> . IS -PIPE-MATERIAL (STEEL, FIBERGLASS OTffER ) N FEET <br /> P T <br /> I -Pd-$INQ CONDITION (GOOD# POOR,, HOLES ) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE Y <br /> FA ' a/ c f ,s ,07 J,e., L [v <br /> I N <br /> E K L <br /> L <br /> D EXCAVATION SIZE: /�' X _) X <br /> S- _ : YDS OF SOIL : <br /> I A 'DEB SOIL TYPE OBSERVATION <br /> N M P - -- SAMPLE N <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH bIMENSION X X _ <br /> I YDS OF SOIL <br /> 0 H DEPTH TO O.W. ! \ <br /> N 2 FT SAMPLING METHOD <br /> 0 1 OF HOURS SINCE bEWATERING: <br /> O OTHER SAMPLE! <br /> 1 LABORATORY: ° SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE:, <br /> VOLUME: <br />