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PHc __HD _ UNDERGROUND TANK CLCSURE / ABANLL,, . IgEN'' INSPECTION <br /> ( SHADED AREA TO qE FILLED IN FOR THE FIRST :- r'NK _ONLY ) <br /> �6�"v,. .. •'c57?� !D, yrn,.'? .4/r' i, <br /> v ;WWI Jaa .ivauvmrurviuvw:utn.rurrvrivrvmrviva �vw. cru[ua/ivmrrivmmivivruruu,• <br /> OWNER NAME I OWNER PHONE # <br /> N w CONTRACTORS L�"� � / l� j� CON . PHONE :# <br /> j E vTit , 3 <br /> i RSSLHD PERMIT # EPA # FIRE PERMIT # ' <br /> ✓ <br /> A r�/rrrr' r �rblGd rd G /G r rear G rG r r r rG r�� /tr <br /> UhIUGiG� <br /> L K l YM ..0 UK= LI N m 1 GI UM rly LU Uri= II <br /> I <br /> INSPECTORli �'r u45 I <br /> DATEd.. a j � rel TANK # 39 - � = <br /> j R I RINSED LY% N ) METHOD RINSE AMOUNT 7 .� , <br /> N RINSATE DISPOSAL SITE H b' <br /> S I <br /> E I MANIFEST # -OR- OTHER <br /> i V VAPORS PURGE) ( METHOD L� L!y� � ` � ` AMOUNT USED <br /> A <br /> P I L . E . L . READING AT REMOVAL ( MUST BE ( 20% ) C ' = L <br /> _ � ;_� <br /> T R COMMENTS I <br /> A i <br /> N j TANK MATERIAL ( STEEL , FIBERGLASS , OTHER ) TANK SIZE <br /> / 0 TANK CONDITION ( GOOD , POOR HOLES ) <br /> N <br /> . i S i PIPE MATERIAL ( STEEL , F73CRGLASS , OTHER ) I # FEET <br /> P T <br /> I PIPING CONDITION ( GOOD , POOR , HOLES ) <br /> N <br /> S DEPTH I SOIL TYPE I OBSERVATIONI SAMP Ewe # <br /> (;) ,/Irl ' x �'� I Lz w v 'rte• �c. <br /> ,I N ! . 7 !d.0 Ell , <br /> c N) <br /> r,ec j K t . ' i, I I� v , L i. <br /> I moisit c f%\ <br /> D k I EXCAVATION SIZE : X X (� I YDS OF SOIL : <br /> � a i <br /> I A DEPTH I SOIL TYPE I OBSERVATION I SAMPLE # <br /> S i P ! I I I I <br /> P j L I P I I I <br /> E I I E I I I I <br /> I I I <br /> T G I TRENCH DIMENSION X X ! YDS OF SOIL <br /> r <br /> 0 H DEPTH TO G . We FT I SAMPLING METHOD <br /> N 2 <br /> 0 I # OF HOURS SINCE DEWATERING : <br /> 0 OTHER SAMPLE : <br /> L <br /> 11. <br /> LABORATORY : SAMPLERS NAME :CLOSURE IN PLACE I MIXTURE : I• VOLUME : <br /> f 2 O .3 ( 10 / fl9 ) DRAW SITE MAP ON REVERSE . <br />