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OF <br />Gct UND WANK CLOSURE/ALAN EENT INSPEC`1'10N <br />(SHADED TO BE FILLED IN FOR THE ST <br />TANK ONLY) <br />G OWNER NAME OWNER PHONE #' <br />L." <br />N s CONTRACTOR�-• <br />- CON. PHON <br />R iSJL°D PERMIT # EPA #0FIRE PERMIT # <br />A TW-, <br />L <br />INSPECTOR C?- DATETANK # 39 - - <br />R RINSED (Y N) METHOD RINSE AMOUNT <br />N RINSATE DISPOSAL SITE L '12rv�G�� i v� <br />S <br />E MANIFEST # —OR— OTHER <br />V VAPORS PURGED (Y ) METHOD � �ii 0 T USED <br />A <br />P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br />O <br />T I R IL COMMENTS <br />A <br />8 u t ti�i 1 TANK SIZE <br />K C Q <br />/ 0 TANK CONDITION ( POOR R' HOLES ) ub,nc <br />P N I tn. -�JL- <br />I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br />P T <br />I PIPING CONDITION (GOOD, POOR, HOLES) <br />N <br />G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />T <br />F A <br />I N ® d <br />E K lacAIA 6201 <br />L <br />DS_ EXCAVATION SIZE: X X r YDS OF SOIL: <br />I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br />N M P <br />S P I <br />P L P <br />E I E <br />C N <br />T G TRENCH DIMENSION X X YDS OF SOIL <br />I <br />0 H DEPTH TO G.W.: r) FT SAMPLING METHOD <br />N 2 LSCS' <br />(� 0 # OF HOURS SINCE DEWATERING : t041 <br />0 OTHER SAMPLE: <br />LABORATORY: NitSAMPLERS NAME: <br />CLOSURE IN PLACE MIXTURE: VOLUME: <br />1111 23 013(7/88) <br />DRAW SITE MAP ON REVERSE <br />