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i <br /> it AHO—EHD — UNDO ,7ROUND TANK CLOSUREIAHAND(I , -NT INSPECTION <br /> (SHADED AREj 0 BE FILLED IN FOR THE Fl- ,T'- <br /> TANK ONLY) <br /> OWNER PHONE # 1, <br /> E <br /> . 01--f -f-I6% M t/) )O <br /> N CONTRACTOR 3c CON. PHONE# <br /> R f SJLHD PERMIT # EPA # FIRE PERMIT # f <br /> TC <br /> INSPECTOR - DATE 3 �* TANK # , — j /5 <br /> _. c t <br /> R RINSED r t Y N} METHOD t f;,5 I u RINSE AMOUNT f,. <br /> N RINSATE�DISPOSAL SITE 7 <br /> S 't1raC'rU, <br /> E MANIFEST # <br /> —OR— OTHER <br />{ V VAPORS PUROD <br /> A <br /> 1 �~C , AMOUNT USED <br /> a P <br /> O L. E. L4 READIN13 AT REMOVAL (MUST BE f 20%) <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL TEEL FIBERGLASS, OTHER) TANK SIZE <br /> I 0 TANK CONDITION (GOOD, POOR, HOLES) <br /> Nxl <br /> O PIPE MATERIAL {STEEL FIBERGLASS, OTHER) # FEE'( <br /> P T <br /> I PIPING CONDITIO (GOOD POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A <br /> I N <br /> E K <br /> L <br /> D :EXCAVATION SIZEr <br /> S X X YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> it S P I ptj <br /> P L P <br /> EI E <br /> C N <br /> I I G TRENCH DIMENSION X X YDS OF SOIL <br /> I1 N 0 H DEPTH To G� W4 : FT SAMPLING METHOD -- <br /> �x # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: x ,. 1r.tz SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br /> "H 237043 ( 10189) DRAW SITE MAA ON REVERSE <br />