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UA DIINGXUUNL YANK CLOSURE/A}AANDONMENT INSPECTIUN <br /> (SHADED A TO BE FILLED IN FOR THE -"ST TANK ONLY) <br /> �1 dC e O�Zj T1 C R_ -n o rYl cu , 1 ,- J ( c' <br /> G OWNER NAME OWNER PHONE <br /> E <br /> N r CONTRACTOROt I CON. PHONE# <br /> c-Fic <br /> cxyo <br /> R '4 SJLHD PERMIT # EPA # iy'i `IO l FIRE PERMIT V <br /> A <br /> L <br /> INSPECTOR �`, � " DATE-211 � , c6c� TANK # 39 <br /> R RINSED (Y N) METHOD RINSE AMOUNT-- <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED Y N) METHOD AMOUNT USED � I <br /> A t <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> O <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL STEEL FIBERGLASS, OTHER) TANK SIZ& `� <br /> K C <br /> / 0 TANK CONDITION (GOODPOOR HOLES) <br /> P N <br /> I LS PLPE MATERIAL STEEL FIBERGLASS, OTHER) # FEET <br /> P IPIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A r\ c0or t`l n l 7 - <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: X Jl X YDS OF SOIL: <br /> S_ o� \. 0 <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 /> OH DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> LF071 OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> Lj <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> i <br /> DRAW SITE MAP ON REVERSE <br />