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S.7LHD -- UNDO,. OUND `t`ANK CLOSURE/A1�NDONMENT I NSi�t;CT 1 UN <br /> { f SHADED ARE.P. "0 BE FILLED IN FOR T1f,C FI + .r TANK ONLY) <br /> IN <br /> or a IrjG- r oiin� <br /> G OWNER NAME '• <br /> E CO5 i �5 ¢ / ' OWNER PHONE' <br /> N CONTRACTORj01' CON. PHONE I I` ; <br /> E <br /> ` CAC <br /> R SJL46 PERMIT A N EPA N �b. I; FIRE PERMIT a <br /> L - <br /> INSPECTOR j6j&fj'e' DATE �2-3'�1?� TANK 1 : 39 <br /> R RINSED Y N) METHOD j frll'n� RINSE AMOUNT12 <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S I <br /> _^ E MANIFEST IF —OR-•i . OTHER <br /> • VA VAPORS PURGED Y N) METHOD �� ���i AMOUNT USED <br /> P L.E.L. READING AT REMOVAL (MUST BE CI 20%) 0 i V LCL. :• <br /> 0 <br />` TR COMMENTS <br /> A Co S •'D' <br /> N TANK MATERIAL STEE , FIBERGLASS, OTMER) y TANK SIZE 35O <br /> K C � <br /> / 0 TANK CONDITION (GOOD, POOR HOLES) <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) V FEET /1,� <br /> P T <br /> I PIPING CONDITION (GOOD, P00 , HOLES)l� _ ,na <br /> N <br /> G DEPTH SOIL TYPE OBSERVATIONi' SAMPLE i <br /> T `' <br /> �+ A O Q?1 O <br /> I N ' lu 1 <br /> E K to , <br /> L !t C <br /> D EXCAVATION SIZE: �0 X r2. X YDS OF SOIL: ,Ids <br /> S- <br /> I A• : DEPTH SOIL TYPE OBSERVATION i SAMPLE I <br /> N M P <br /> S P' I 14 <br /> P L P <br /> E I LE <br /> C N <br /> T GTRENCH DIMENSION X X _ YDS OF SOIL <br /> I ' <br /> O H DEPTH 'TO G.W. : FTTSAMP L rl m G PETHOD t <br /> N 2 " <br /> 0 1 OF HOURS SINCE DEWATERING: loy- <br /> ❑O OTHER SAMPLE: ��se i' `spcxla <br /> LABORATORY: /7 jSAMPLERS NAME. <br /> LJCLOSURE IN PLACE MIXT E: 1j i# VOLUME: <br /> DRAW SYTE NAP ON 4EVERSE <br /> Ell 23 0,13(7/88) �� <br />