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J - UIJDLI.,: h_ . ._ TANK CL JS URE/AILANDO ' CN'1' INSPL•'CTIUN <br /> (SHADED AR TO BE FILLED IN FOR THE IST TANK ONLY) <br /> !TTT-11 m smil <br /> G < OWNER NAME <br /> OWNER PHONE <br /> E <br /> N < CONTRACTORS CON. PHONEq <br /> E <br /> R SJLHD PERMIT tl EPA I FIRE PERMIT q <br /> INSPECTOR ' �1R C� DATE ��j��� TANK tl 39 <br /> R RINSED (YIN) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST I -OR- OTHER <br /> V VAPORS PURGED (Y N) METHOD AMOUNT USED/-�� <br /> A r <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) /J <br /> 0 <br /> T R COMMENTS <br /> A - <br /> N TANK MATERIALK( STEEL ' FIBERGLASS, OTtISE2) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION( (GOOJj, POOR, HOLES) <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) tl FEET /�/✓� l� L2 <br /> P T <br /> I PIPING CONDITION {GOOD) POOR, HOLES ) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE tl <br /> T <br /> F A rw f> w <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: X X YDS OF SOIL : <br /> s- <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE I <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 /> 0 N 2 H DEPTH TO C.W. : FT SAMPLING METHOD <br /> 0 tl OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPL'= <br /> LlLABORATORY: � SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />