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SJLf1U — UNDL•'1 ��RUUND 'TANK CLOSURE/A1AAND0N'a.LNT INSPECTION <br /> (SHADED ARC TO BE FILLED IN FOR THE F. ''T TANK ONLY) <br /> �r r y <br /> G OWNER NAME OWNER PHONE A <br /> E <br /> N < CONTRACTOR No r (fa ! CON. PHONE# ' <br /> E <br /> R SJLHD PERMIT I EPA I FIRE PERMIT YA . . . . . . . . ."w - I . . . . . . . . . . . . . . . . . . . . .I . . . . . . . . <br /> INSPECTOR DATE TANK M 39 - a - <br /> R RINSED (Y/N) TMETHOD RINSE AMOUNT <br /> - I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST II -OR- OTHER <br /> V VAPORS PURGED N METRO AMOUNT USED <br /> - <br /> A -ggmffi�m- —F <br /> . P L.E.L. READING AT REMOVAL (MUST Bi < 20%) <br /> 0 <br /> T R COMMENTS Vo lopod tb* J1703JC7.p*I'+S• <br /> A <br /> N TANK MATERIA �TEE FIBERGLASS, OTHER) TANK SIZE tea& <br /> K C <br /> / 0 TANK CONDITION (GOOD, POOR, OLES led r-;11, 04-d&d*,04 <br /> P N <br /> I PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) !I FEET <br /> P [ Ts <br /> I PIPING CONDITION (GOOD POOR _H4LES4-� <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE II <br /> T <br /> F A <br /> I N �, 4 <br /> E K <br /> L <br /> D EXCAVATION SIZE: X X YDS OF SOIL: <br /> S- <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> N M P <br /> S P I S Ai <br /> .n <br /> P L P <br /> EI E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I <br /> 0 H DEPTH TO G.W. : FTf <br /> S AMPLING METHOD <br /> N 2 <br /> 0 I OF HOURS SINCE DEWATERING: <br /> OTHER SAMPLE: <br /> a <br /> LABORATORY: FG SAMPLERS NAME: <br /> „ i <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> Ell 23 0-13(7/88) 99 <br />