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�4w� ...i, <br /> SJLHD - UNDERGROUND 'TANK CLOSURE/AItANDONML•'NT INSYEC-i-juN <br /> _ (SNAD.E(yDA.RJ.(rAJ.!. Tj•/yO B.R FILL(yE•](D.J IN FOR THE FIRST TANK ONLY) <br /> ��Tl•!I•i�•ll•TI.7••I.I.1••e•i��I•�1+ <br /> • S S.E 6� ,F .�QY�U, C-r�i t <br /> G + OWNER NAME '�. <br /> E <br /> �Jrc� OWNER PHONE 1 <br /> N CO(JTRACTOR 7�vr Oil � CON. PHONEI ' <br /> E ` <br /> R SJLH PERMIT 1 w(�( EPA 1 004( c"v7dy"I FIRE PERMIT 1 <br /> mm <br /> INSPECTOR C' C7Z DATE TANK 1 39 - p3 <br /> R RINSED WN) METHOD �" !o RINSE AMOUN /a <br /> • I T <br /> N RINSATE DISPOSAL SITE /uvr Ccs <br /> S <br /> E MANIFRST I -OR- OTHER <br /> V VAPORS PURGED (Y%N) METHOD brJ ,A AMOUNT USED <br /> s <br /> •P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STELA FIBERGLASSr OTHER) TANK SIZE <br /> K C ©Oc7 <br /> / O TANK CONDITION (GOOD, POOR,. LES) <br /> P N <br /> ` yp T PIPE--NA TER-IAL-{-STEEL, FIBERGLASS, OTHER) 4 FEET <br /> I PI-Pd-NG-CONDITTON-(000)3,- POOR, HOLES) <br /> N <br /> G T DEPTH SOIL TYPE OBSERVATION SAMPLE U <br /> F A ' <br /> I N /�3 L- <br /> E K <br /> L <br /> D EXCAVATION SIZE: X 7 X -Z YDS OF SOIL : <br /> s: <br /> I A TH SOIL TYPE OBSERVATION <br /> N M P - - -- SAMPLE 1 <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> I G TRF�NCH DIMENSION __ X __ X YDS `OF SOIL Y 3 <br /> 0' H DEPTH TO C.N. : <br /> N 2 FT SAMPLING METHOD �pussf. 2- <br /> 0 1 OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> f LABORATORY: �0/iv or,e SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: <br /> , VOLUME: <br /> DRAM <br />