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---y llw - U"Vb:' GAUU"L) TANK CLOSURE/A$AND(' LENT INSPECTION <br />(SHADF,.D AR TO BE FILLED IN FOR THE P`WST TANK ONLY) <br />Ell 2:3 043(7/88) DRAW SITE MAP ON REVERSE <br />...{���Ll•O <br />PP <br />���.Ii�i.0000i• <br />EL <br />I <br />u.) <br />acs STK <br />G <br />OWNER NAME <br />OWNER PHONE # <br />E <br />N <br />< CONTRACTOR �a) <br />( <br />CON. PHONE# <br />E <br />R <br />SJLHD ERMIT # EPA # FIRE PERMIT # <br />INSPECTOR j{ry5f i DATE 6y TANK # 39 - - n <br />_ <br />R RINSED Y ) METHOD \ C (pu_ i� n�\ RINSE AMOUNT <br />N RINSATE DISPOSAL SITE 2g�, C <br />S J l co <br />E <br />MANIFEST # -OR- OTHER <br />V <br />A <br />VAPORS PURGEDY N) <br />METHOD�,r �� <br />AMOUNT USED lO , <br />P <br />0 <br />L.E.L. READING AT REMOVAL (MUST BE 208) <br />T <br />R <br />COMMENTS <br />A <br />jJ <br />K <br />,. C <br />TT y,•. �c`p* y, ;. cl1v LlaJr V1'ila:.lt <br />� iANK SIZE <br />/ <br />0 <br />TANK CONDITION (G POOR, HOLES) <br />P <br />N <br />I <br />S <br />PIPE MATERIAL STEE FIBERGLASS, OTHER) <br /># FEET <br />P <br />T_ <br />I <br />PIPING CONDITION (GO D, POOR, HOLES) <br />N <br />G <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />T <br />F <br />I <br />_ <br />A I - <br />N <br />E <br />K cc,�ldn <br />L <br />DS <br />EXCAVATION SIZE: X -7 X <br />YDS OF SOIL-' <br />I <br />A <br />DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />N <br />M <br />P <br />S <br />P <br />I <br />P <br />L <br />P <br />E <br />I <br />E <br />C <br />N <br />T <br />G <br />TRENCH DIMENSION - X — X _ YDS OF SOIL. <br />I <br />O <br />_' _ <br />[]H <br />DEPTH TO G.W.: FT SAMPLING METHODN <br /># OF HOURS SINCE DEWATERING: <br />❑O <br />OTHER SAMPLE: <br />LABORATORY: <br />SAMPLERS NAME: <br />CLOSURE IN PLACE MIXTURE: <br />VOLUME: <br />Ell 2:3 043(7/88) DRAW SITE MAP ON REVERSE <br />