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S.iLho - UNb ERGRUOND TANi: CLOSURE/AlAANDONMENT INSPECTION - `> <br /> (SHADED AREafO BE FILLED IN FOR THEF T TANK ONLY) - <br /> � t – r <br /> G e OWNER NAME /. OWNER PHONE # <br /> E l EYS w 1 L <br /> N < CONTRACTOR <br /> E CON. PHONE ,� <br /> R < SJLHD PERMIT # EP" %✓lA �-o/' FRE PERMIT # <br /> A <br /> L <br /> INSPECTOR ' DATE TANK # 39 - J - � <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 Og 7,f� AMOUNT USED -/ <br /> A �v <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIALA STEEL, FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD POOR, HOLES ) <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET 46 <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A 2 i <br /> I N 2 to c 921 i�� <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 LAXL YDS OF SOIL <br /> I <br /> O H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: <br /> LABORATORY: � L SAMPLERS NAME: JS/}4-6 f�4jlG p/ <br /> CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />