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U 'TANK CLOSURE/AltANDf'N.MENT INSPECT10N <br /> TCS THE tRST �1NK ONLY) <br /> (SHADED A_ FILLED IN FOR <br /> 34 <br /> J J <br /> (, OWNER 'NAME OWNER PHONE � ) { �� <br /> E -_---- <br /> �-- - --- <br /> / I <br /> N CONTRACTOR Com, CON . PHONEq <br /> E <br /> R { SJLHD PERMIT # --- EPA # tA� �3 FIRE PERMIT # <br /> A � t <br /> I <br /> L <br /> E Cy zus TANK , 39 <br /> INSPECTOR DAT <br /> �5� <br /> R RINSED ( /N) METHOD i RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # q -OR- OTHER <br /> _ V VAPORS PURGED (Y N) METHOD �gyC.� AMOUNT USED D� js <br /> A <br /> . P L.E.L. READING AT REMOVAL (MUST BE C 20%) --- <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL ( TEEL FIBERGLASS, OTHER) TANK SIZE fo <br /> K C ��!c r�c Ttc v�K �x�k c'd h Lc rip V^% <br /> / O TANK CONDITION GOOD POOR, HOLES ) <br /> P N f <br /> 1 I S PIPE MATERIAL ( TEEL, FIBERGLASS, OTHER) I FEET <br /> .(�4 <br /> I PIPING CONDITION (GOOD, l7OR,) HOLES } (��,-� 'tC7� eV`,;ts,n.'� <br /> N - <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T LO-PAMi '!"[ oL.o i t KOFIi= T <br /> F A <br /> I H , r t r <br /> E K <br /> D EXCAVATION SIZE: �X _u X _LL YDS OF SOIL!,-, <br /> S- J <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I <br /> P L P <br /> E I E `� �� Z <br /> i <br /> T G ENCH DIMENSION X 1•S�X YDS OF SOIL �lnp��„4� <br /> I <br /> O H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 1 <br /> Fo-11 <br /> OTHER SAMPLE: <br /> LABORATORY' LPV�� ``~k2 SAMPLERS NAME: �t�rl `" <br /> ----Jl — <br /> CLOSURE IN PLACE MIXTURE: VOLUME: vj >q I <br /> I <br /> DRAW SITE MAP ON REVERSE <br /> Ell 23 01:3(7/88) <br />