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JJ LtIU - UALJ 'l URUUNU TANI( CLUSURE/AAAND' NHEN'1' IN5PECT1uN <br /> (SHADED A TO BE FILLED IN FOR THE TANK ONLY) <br /> T i S- 5/S G J��t S(CCTO <br /> G < OWNER NAME yL��{} '� F,C � 7�1 OWNER PHONE <br /> E <br /> N < CONTRACTOR � c L e1,1ST Uf72 CON. PHONE# <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # /� S <br /> A .. 5 <br /> L NOR I <br /> INSPECTOR_/q LEY L.DATE /ll/(vl�g TANK # 39 - <br /> IRINSED Y METHOD C� RINSE AMOUNT- -- <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER -- <br /> V VAPORS PURGED Y/9) METHOD ICC AMOUNT USED <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 208) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZE �G�a <br /> K C <br /> / 0 TANK CONDITION (GOOD, POOR, OLES)' <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # 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 ) w011 11 QILcs _ <br /> I N <br /> E K {' et <br /> L c fsidt <br /> D EXCAVATION SIZE: X X SOIL: jroX SSC{ <br /> S- <br /> I A PTH S IL 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 /> 0 H DEPTH TO G.W. : _J�� FT S „ PLING METHO <br /> N 2 { ', <br /> 0 # OF HOURS SINCE DEWATERING: Nl(} Str1 ';nYpnC , by <br /> 0 OTHER SAMPLE: <br /> LABORATORY: � SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: — VOLUME: — <br /> DRAW SITE MAP ON REVERSE <br />