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JgILnu — UflUZhUNQVAVV TANK CLOSURE/ABANDONMENT INSPECTIONE <br /> (SHADED AREA (�` BE FILLED IN FOR THE FI RSP-,,.TANK ONL X) <br /> 4 <br /> G OWNER NAME511 <br /> / ' OWNER ,PHONE # <br /> E <br /> N CONTRACTOR -CON.. PHONE V, <br /> E - xti � ��°C <br /> R SJLHD PERMIT # FIRE PERMIT # <br /> A <br /> L <br /> INSPECTOR DATE Z� TANK # 39 G <br /> R RINSED (Y N. MEQ 0 RINSE &NT <br /> I <br /> N RINSATE DISPOSAL SITE . <br /> S <br /> Is <br /> E MANIFEST # f1` ._- . ;�:-OR- OTHER <br /> V VAPORS PURGED (Y N) 1 "IMETHOD O AMOUNT USED�S .y <br /> A s � 1 <br /> P L.E.L. READING-AT. REMOVAL ..(MUST:`'BE < 20%) <br /> 0 „.. <br /> T R COMMENTS <br /> Afl <br /> N TANK MATERIAL (STEEL FIBERGLASS, OTHER) TANK SIZE xl <br /> K C ;, do d µ <br /> / 0 TANK CONDITIO� POOR, HOLES). � ' <br /> P N <br /> I S PIPE MATERIAL (iTEEL FIBERGLASS, OTHER) #. FEET #` <br /> I PIPING CONDITION (GOOD OR HOLES) "` F <br /> N <br /> G DEPTH SOIL TYPE ';OBSERVATION k SAMPLE # <br /> T �. <br /> F A <br /> I N <br /> E <br /> L <br /> D EXCAVATION SIZE: X X 'YDS OF SOIL: H <br /> S- <br /> I A DEPTH " SOIL TYPE iOBSERVATION y • SAMPLE :# r <br /> 3 E: <br /> N M P <br /> S P I z' r.: <br /> � r <br /> P L P w . 1 <br /> E I <br /> C N <br /> T G TRENCH DIMENSION XX.. YDS OF SOIL <br /> 0 H DEPTH TO G.W. : FT. i:: SAMPLING METHODI�.v� <br /> N <br /> 0 # OF HOURS SINCE DEWATERING:' ` <br /> e . <br /> OTHER SAMPLE: <br /> LABORATORY: . '`' SAMPLERS NAME: <br /> CLOSURE. IN PLACE MIXTURE::' VOLUME: <br /> DRAW SITE MAP ON REVERSE . <br />