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SJLHD - UNPAOUND 'TANK CLOSURE/AltAND00%N'T INSYEC'TIUN <br /> (SHADED ARS TO BE FILLED IN FOR THE F-3pm.1ST TANK ONLY) <br /> = = . . . . . . . . . . . . . . <br /> TRSJLHD <br /> ER NAME S� C, OWNER PHONE # <br /> TRACTOR , �� � CON. PHONE cf((Q j2 Sa - <br /> PERMIT # EPA # FIRE PERMIT # <br /> .c � ,ut <br /> INSPECTORI iDATER-X-Q j I TANK # 39!Re-r2 'j_T- <br /> R RINSED Lv N) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE QO <br /> S <br /> E MANZFUT # -OR- OTHER <br /> V VAPORS PURGED ��G/N) METHOD i C-R. AMOUNT USED <br /> A <br /> •P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> N TANK MATERIAL TEEL FI ERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION OOD, POOR, HOLES) h2 <br /> P N r <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEETdr11 G 1 <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # D <br /> F A saw.ot bc¢,C `"" <br /> I N � <br /> E K <br /> L <br /> D EXCAVATION SIZE: X X YDS OF SOIL: <br /> 3- <br /> I A . DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I IV aZ%A4g <br /> P L P <br /> n E I E <br /> C N <br /> T G . TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> = I 0 H DEPTH .TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 I OF HOURS SINCE DEWATERING: <br /> p OTHER SAMPLE: <br /> � L <br /> LABORATORY: GA-. SAMPLERS NAME: <br /> IL <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> Ell 23 0113(7!RR) <br />