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6jtstfu - U"DP: 'GhUUNL 'DANK CLOSURE./A$ANDONAENT INSPECTION <br /> (SHADED AIM TO BE FILLED IN FOR THE RST WANK ONLY) <br /> 'csJ Lc+L r C-k- cc <br /> G OWNER NAME b �`l�� I �� OWNER PHONE # 1--1�11_ C`G EN CONTRACTOR . 1 u� ��� CON. PHONE# C L4 �74 � <br /> E �JR SJLHD PERMIT # EPA #C z ;7_ FIRE PERMIT # <br /> A <br /> L <br /> INSPECTOR C. DATE_-311 TANK # 39 cj-- <br /> R RINSED Y N) METHOD ��� RINSE AMOUNTr <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y N) METHOD AMOUNT USE -�S)b <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T LRll <br /> COMMENTS <br /> A <br /> N TANK MATERIAL TEFL, FIBERGLASS, OTHER) TANK SIZEr� � <br /> K C <br /> / 0 TANK CONDITIONGOOD POOR, HOLES) no �b <br /> P N <br /> I S PIPE MATERIAL ( TEE FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T nn cl,r 1.(l i c-4 bch-x <br /> F A n <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: ZX 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 /> 0 H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> El <br /> 0 # OF HOURS SINCE DEWATERING: <br /> OTHER SAMPLE: — <br /> LABORATORY: � _ SAMPLERS NAME:r-� y�Y1� <br /> CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> DRAFT SITE MAP ON REVERSE <br />