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DJLlu - UNLnaURUUNL TANK CLOSURE/ABANDONMENT INSPECTION <br /> (SHADED AR TO BE FILLED IN FOR THE F T TANK ONLY) <br /> G < OWNER NAME OWNER PHONW # <br /> E <br /> N < CONTRACTORS�oGti aDq CON. PHONE# <br /> E ( yea- So�a- <br /> 'v <br /> R < SJLHD PERMIT # EPA # U FIRE PERMIT # <br /> A <br /> L <br /> INSPECTOR I ;' RP DATETANK # 39 - <br /> R RINSED (YIN) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y/N) METHOD AMOUNT USED <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL ( STEEL, FIBERGLASS, OTHER) FTANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES ) <br /> P N <br /> I S PIPE MATERIAL ( STEEL, FIBERGLASS, OTHER)T# FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES ) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A <br /> I N ° Sr <br /> E K <br /> L <br /> D EXCAVATION SIZE: X X 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 /> E I E <br /> C N <br /> T G TRENCH DIMENSION X — X YDS OF SOIL <br /> I <br /> Omo DEPTH TO G.W. : FT SAMPLING METHOD <br /> N # OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: <br /> LABORATORY: SAMPLERS Nt1tAME:�pi�t�� O <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />