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SJLHD - Ur'J__'!RGRUUND TANK CLOSURE/Aid+-'.,`-4MENT INSPECT10N <br /> (SHADE!. A.ZA TO BE FILLED' IN FOR TF` IRST TANK; ONLY) . <br /> Iff"WIP, <br /> G OWNER NAME , OWNER PHONE I. <br /> E <br /> N i CONTRACTORCON. P.HONE# ' , <br /> E j f >; <br /> R SJLHD PERMIT # EPA <br /> A � . . . # ` FERE PERMIT:a '# <br /> Is , <br /> INSPECTOR/5. DATE��Izc'� TANK # 39 <br /> R RINSED ) METHOD4r, RINSE AMOUNT 'LJK <br /> N ,' RINSATE DISPOSAL SITE -,?' ' <br /> p <br /> E MANIFEST # -OR- OTHER <br /> V :, VAPORS PURGED ((DN.) METHOD DRy (Ce- AMOUNT .USED <br /> PJ L.E.G. READING AT REMOVAL (MUST BE C 20%) <br /> 0 <br /> A R it COMMENTS -- - ' <br /> N TANK MATERIAL ( TEE , FIBER,GLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION GOO POOR„ HOLES) _} r. . :E <br /> P I N <br /> I S PIPE MATERIAL TEEL, FIBERGLASS, OTHER} # FEET `` <br /> P T <br /> I PIPING CONDITION (GOOD, OOR) HOLES) <br /> N s <br /> G DEPTH SOIL TYPE OBSERVATION : SAMPLE # <br /> T. <br /> F• "3 v Nonce ,� <br /> o& -932geebe _ ,. <br /> E K _ DE „ . <br /> L ,; } <br /> D EXCAVATION SIZE: 40 X� Z8 X �_ YDS OF SOrIL'• k <br /> S- • <br /> I A DEPTH SOIL TYPE OBSERVATION , SAMPLE p' <br /> N M P <br /> S P I <br /> P L P u <br /> E I '' E F <br /> C N <br /> T G TRENCH DIMENSION X`i X YDS OF SOIL' <br /> Ikj <br /> ' 0 H DEPTH TO G.W. .er _ •, FT SAMPLING METHOD.!.a <br /> N 2' e' i. <br /> 0 1 OF HOURS SINCE DEWATERING: _4�_ <br /> 1 <br /> OTHER SAMPLE: <br /> LABORATORY: DELTA C-nv, o�ME � SAMPLERS NAME•.' <br /> .� 0 <br /> CLOSURE IN PLACE MIXTURE: '"- + VOLUME.:1�� <br /> DRAW SITE MAP ON REVERSE <br /> 111 23 013(7/88) <br />