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SJLHD - UNG -'ZROUND 'DANK CLOSURE/A4.AND'k �_`:N'r INSPEl:TIM4 <br /> x (SHADED ARE�rO BE FILLED IN FOR rx� :FYwJT TANK ONLY) <br /> l a,��/• C/n�an S <br /> G OWNER NAME DOWNER PHONE I <br /> N CONTRACTOR S efiC c7 <br /> 'CON. PHONE R <br /> E C - <br /> CACOaa�ofvOgg'. ,. ,a '• <br /> R SJLH PERMIT f1 EPA !I FIRE PERMIT Ir ja887 ' <br /> �i <br /> INSPECTOR n <br /> C7Z_ DATE �-�oa-�9' TANK ';@ 39 - o221/41 - Q:/ it <br /> R RINSED ON) METHOD. RINSE AMOUtYr <br /> N RINSATE DISPOSAL SITES/rG�sr <br /> E MANIFEST 0 -OR- - ',:OTHER :m....._,...�,.'� <br /> V VAPORS PURGED (Y/N} METHOD AMOUNT USED <br /> .P L.E.L. READING AT REMOVAL (MUST BE C 20%) . <br /> O <br /> TR COMMENTS k <br /> A -- <br /> N TANK MATERIAL((S DL FIBERGLASS, OTHER) TANK SIZE <br /> K C 5~ ov <br /> / 0 TANK CONDITIONG00 POOR,,- HOLES) <br /> P N <br /> i. <br /> I S PIPE MATERIAL TEE , FIBERGLASS OTHER) FEET <br /> p T ' <br /> I PIPING CONDITIO (G00 POOR; HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE V <br /> T : <br /> F A 3srn Flu Q drscc�/va� v}, / 4E . <br /> E K 'F <br /> LF <br /> D EXCAVATION SIZE: /5 X X <br /> 3 ,l� YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE .�I ' <br /> N M p <br /> S P I sQ c w' <br /> P L P f N <br /> E I EAF <br /> C N �a <br /> T G TRENCH DIMENSION X' X i YDS OF SOIL �. <br /> O H DEPTH TO C.W. : ' FT SAMPLING METHOD <br /> N 2 <br /> 0 OF HOURS SINCE DEWATERING: i <br /> ILOTHER SAMPLE: <br /> LABORATORY: 6L <br /> SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON RL`VERSF <br /> Ell 23 043(7/88) <br />