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SJLHD -- UNL '3ROUND 'TANK CLOSURE/AEtANDIllsNT I14;;YisC:'T1UN <br /> (SHADED AR !r TO BE FILLED IN FOR THE kl_RST TANK ONLY) <br /> . . . . . . . . . . = = =QT'' <br /> Am Lwe <br /> 0, J 6 0 �cd TLS o s- <br />- G OWNER NAME OWNER PHONE 9 2-09 <br /> E A�7 <br /> N ? CONTRACTOR 0// CON. PHONER ' <br /> E <br /> R SJLHD PERMIT I EPA, I FIRE PERMIT 0 gg-p3i� <br /> L � ,UR � = <br /> INSPECTOR C� OL I. DATE �p/y/ j TANK 1 39 -- _ / WO - Q/_ <br /> R RINSED �N) METHOD L"--A4 1h RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S ie �j Sr'vrGCs <br /> E MANIFEST I - -OR- OTHER <br /> __T <br /> V VAPORS PURGED ON) METHOD dv �c e AMOUNT USED /Uf�s <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIALSTEE FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES) <br /> P N <br /> ' I S PIPE MATERIAL TEE , FIBERGLASS, OTHER) FEET <br /> P T <br /> I PIPING CONDITION - GOOD POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE Ik <br /> T <br /> F Agel'fc / n �r <br /> I N <br /> E K <br /> L - <br /> D EXCAVATION SIZE: lo?, XX �� YDS OF SOIL: <br /> S_ <br /> : I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I <br /> P L P <br /> C N <br /> T G TRFNCH DIMENSION X X YDS OF SOIL <br /> I <br /> ' 0 H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 I OF HOURS SINCE DEWATERING: <br /> O J OTHER SAMPLE:. <br /> �LLABORATORY: EA <br /> PLERS NAME: C el 4w <br /> huc <br /> CLOSURE IN PLACE MIXTURE: r TVOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> 111 2:1 0111(7/88) <br />