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SJLtiU - UNDEe'RUUND 'TANK CLOSURE/ABANDON' 'NT INSPECTION <br /> (SHADED ARE. 'O BE FILLED IN FOR THE F1 TANK ONLY) <br /> .. . . . . . . . . . . . . . . . . . .. . <br /> "le . 5t <br /> G OWNER NAME f�t, i TSG OWNER PHONE # 20/ _ <br /> E /' <br /> N CONTRACTOR 565--macCON. PHONE# <br /> E <br /> R SJLHP, PERMIT I A) A EPA #� L FIRE PERMIT # 1-3 <br /> A j <br /> L <br /> INSPECTOR 00 (t DATE2 ZZ.C�F TANK # 39 <br /> R RINSED Y N) METHOD�r 2(iy� RINSE AMOUNTg� <br /> I <br /> N RINSATE DISPOSAL SITE <br /> �/ j ilk <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED N) METHOD _ AMOUNT USED ��S <br /> A <br /> P L.E.L. READING AT �REMOVAL (MUST BE < 20%)C-�7Z-9,9 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEE , FIBERGLASS, OTHER) TANK SIZE 2 Co <br /> K C <br /> Op / 0 TANK CONDITION (GOOD, POOR HOLES) <br /> P N <br /> I S PIPE MATERIAL (STEEL,)FIBERGLASS, OTHER) # FEET � rj <br /> P T <br /> I PIPING CONDITION (GOOD, POO), HOLES)-,P" <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION Li Jh SAMPLE # <br /> T <br /> 1 <br /> , wvl <br /> E K <br /> L <br /> D EXCAVATION SIZE: IOC X X 3_� YDS OF SOIL: <br /> S- <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I p ! Trl <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION / X X YDS OF SOIL <br /> I — <br /> OmoDEPTH TO G.W. : FT SAMP N METHOD <br /> N I OF HOURS SINCE DEWATERING: � -- elf` p <br /> ❑O OTHER SAMPLE: SPI oS <br /> LABORATORY: Li� SAMPLERS NAME: <br /> — - -- - - <br /> CLOSURE IN PLACE MIXTURE• VOLUME: <br /> DRAW SITE MAP ON VEVERSE ' AK <br />