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SjLHU — UNDr: RUUND TANK CLOSURE/AB 'ANDONT INSPECTION <br /> (SHADED AREAWO BE FILLED IN FOR THE FI TANK ONLY) <br /> 3 <br /> G OWNER NAME � OWNER PHONE r� $38 _35y <br /> E <br /> N CONTRACTOR (.JWAx,ttvda� � Cae eLr' CON. PHONEM � <br /> E <br /> R SJLHD PERMIT EPA Yg5 FIRE PERMIT )i - QLf7j� <br /> t <br /> . . . . . . . <br /> L . <br /> INSPECTOR DATE a- TANK t 39 - <br /> R RINSED Y/ ) METHO Nar _a �� cis RINSE AMOUNT` <br /> I n <br /> N RINSATE DISPOSAL SITE(�Xi QUI C CQznS <br /> S <br /> E MANIFEST M -OR- OTHER <br /> K VAPORS PURGED (Y)N) METHOD (!1 AMOUNT USED,-100 (65 <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE C 20%) Uc- L <br /> 0 <br /> T R COMMENTS <br /> A ��� " <br /> N TANK MATERIAL_ (STEEL, FIBERGLASS,: OTHER) TANK SIZE 1L Q©uXI' jL <br /> K C <br /> N (GO <br /> TANK CONDITION OD, POOR, HOLES) -lon( ° �'` <br /> P ��� <br /> I S PIPE MATERIALTEEL' )FIBERGLASS, OTHER) I FEET CJ Pei <br /> P T <br /> I PIPING CONDITION TGOODr POOR, HOLES) CnnlvGcfor s1� Ce owvti lna <br /> N e e <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE @ <br /> ' F A r -ose d i on 7 <br /> ' (+ :� -Ai, ,r„ E E b <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 J ,n <br /> 0 H DEPTH TO G.W. : F'f� SAMPLING METHO / CLCO � <br /> N 2 n or a r w <br /> 0 M OF HOURS SINCE DEWATERING: we abs✓nry �� <br /> OTHER SAMPLE: x +r��x5 1_cake, ��0115 Pll� o(p <br /> I _ �� OI L-� IL2 <br /> LABORATORY: t,`F� � - SAMPLERS NAME: J <br /> CLOSURE IN PLACE MIXTURE: Jl� VOLUME: 1 <br /> /�/ �/ <br /> DRAW SITF. MAP ON REVERSE <br />