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S.1LHtl - uNDetl RUUNU TANK CLOSURE/A$ANDOvty *!T :.INSPECTION. Y, <br /> 1, .. • <br /> (SHADED AF- BE FILLED IN FOR �THE :- <br /> TAMK ONLY) <br /> Ahvezn, . <br /> -OWNER PHONE ,l <br /> G OWNER NAMEr 6 ; <br /> E T � � T <br /> N < CONTRACTOR ��Cc.EMD�! CON: PHONE# <br /> E 1a8 <br /> R SJLHD PERMIT #' EPA # FIRE PERMIT ,#. <br /> A <br /> LFi <br /> INSPECTORIi._ro_z,,-Y DATE 8y -TANK # 39 <br /> i <br /> R RINSED (YLl <br /> AH METHOD n _R` RINSE_.AMOUNT, <br /> N RINSATE DISPOSAL SITE <br /> :3 S rt <br /> E J MANIFEST # -OR- OTHER <br /> V VAPORS PURGED Y N) METHOD -R AMOUNT USED,y ' <br /> A �5_ <br /> IE,"H: <br /> P - L.E.L. READING AT 'REMOV L A (MUST BE :<° 20$) <br /> 0 <br /> 41 <br /> T RCOMMENTS <br /> A <br /> zm <br /> N TANK MATERIAL TEFL FIBERGLASS, OTHER) :TANK `SIZEi .< <br /> =, K c .. <br /> / 0 TANK CONDITION { M POOROLES HOL&.X09`/ .HftT 36&'J Ctb5;E-fl$'� <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) f I _FEET ='{'1012�P IT <br /> p T <br /> I PIPING CONDITION - (GOOD, POOR, HOLES) <br /> r fp N <br /> G DEPTH SOIL TYPE OBSERVATION x . <br /> 'SAMPLE ,# <br /> ' �• A �L7 0 o <br /> E K <br /> L <br /> -;� D EXCAVATION SIZE: X K ,� YDS OF SOIL:: I� <br /> S- <br /> '` I A EPTH SOIL TYPE BSERVATION , ' 'SAMPLE # <br /> NM P <br /> IS P I <br />_- _ P L p _ <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION XX YDS OF SOIL <br /> I <br /> 0 H DEPTH TO G.W. l�Cl'1 FT SAMPLING METHOD <br /> N 2 �' <br /> 0 # OF HOURS SINCE DEWATERING: <br /> OTHER SAMPLE: <br /> LABORATORY; SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE:} VOLUME: <br /> ' I <br /> DRAW SITE MAF ON REVERSE <br /> INSPECTOR t, 9>qCE VED BY <br /> ZVI <br />