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SJi..IiU - UL4111::K6KUUNU TANK <br />. _.._ mn nGr p TI.L <br />CLOSURE/ A$ANDON11liNT INSYEG'"uw <br />ED IN FOR THE F �ST TANK ONLY)������ . <br />G <br />E <br />N <br />OWNER NAME- / Uwnrtt rnvi.+ . GOY -']L Fl- S`) J / <br />f,UWrhPr 13gi N vri <br />OM Ff21I'klN CON. PHOMEH 2��_ '165 -5 -- ; <br />< CONTRACTOR CO, <br />E <br />R <br />SJLHD PERMIT Y EPA FIRE PERMIT A <br />LWm <br />INSPECTOR,, Hur,it DATE /Vj6 TANK R 39 <br />R RINSED (Y/N) METHOD RINSE AMOUNT <br />N <br />E <br />8 y tr <br />RINSATE DISPOSAL SITE <br />MANIFEST I p -OR- OTHER <br />VAPORS PURGED ( Y/N D METHOD _ ' <br />A,110 '11T USED <br />V <br />i <br />A <br />P <br />L.E.L. READING AT REMOVAL (MUST BE < 20%) <br />0 <br />T <br />R <br />I COMMENTS <br />J — <br />A <br />N <br />TANK MATERIAL STEEL ,FIBERGLASS, OTHER) <br />TANK SIZE <br />- <br />K <br />C <br />/ <br />P <br />0 <br />N <br />TANK CONDITION ( GOOD, POOR, HOLES) Fair Ne 0b/;d,AS ha p <br />I <br />P <br />S <br />T <br />_ <br />PIPE MATERIAL STEEL' FIBERGLASS, OTHER) <br />— <br />I FEET ? <br />I <br />PIPING CONDITION (GOOD, POOR, HOLES) ? <br />t1 <br />— <br />G <br />DEPTH <br />SOIL TYPE <br />OBSERVATION SAMPLE Y <br />T <br /><' T.5 <br />I <br />) <br />N <br />E <br />K <br />L <br />D <br />S <br />EXCAVATION SIZE: X X <br />- <br />YDS OF SOIL: <br />I <br />N <br />A <br />M <br />P <br />DEPTH <br />SOIL TYPE <br />OBSERVATION <br />SAMPLE q <br />S <br />P <br />I <br />_- <br />P <br />L <br />P <br />E <br />I <br />E <br />_ <br />C <br />N <br />_ <br />T <br />I <br />G <br />TRENCH DIMENSION X X <br />— — — <br />YDS OF SOIL <br />O <br />N <br />H <br />2 <br />DEPTH TO G.W.: FT <br />- <br />SAMPLING METHOD <br />Y OF HOURS SINCE DEWATERING: <br />( n0 <br />I <br />LOTHER SAMPLE: <br />L0 <br />LABORATORY: + y7 /P`L (,nn <br />SAMPLERS NAME: Dark Orr (� <br />CLOSURE IN PLACE <br />MIXTURE: <br />VOLUME: <br />DRAW SITE NAP ON REVERSE <br />