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UNDERGRUUNU 'TANK CLOSURE/AELANDONMENT INSPECTION <br /> (SHADED ARI TO BE FILLED IN FOR THE F ST TANK ONLY) <br /> . . <br /> E OWNER (NAME a--?A d U 6 <br /> OWNER PHONE <br /> E s CONTRACTOR /. n /�J1 ! 1�' ��,�� <br /> (�-C G � ICON. PHONE# <br /> R < SJLHD PERMIT # EPA # <br /> A FIRE PERMIT # <br /> L <br /> INSPECTOR DATE ( TANK # 39 - <br /> R RINSED Y ) METHOD --r <br /> I I� n� RINSE AMOUNT V/� <br /> S RINSATE DISPOSAL SITE <br /> E MANIFEST I -OR- OTHER <br /> V VAPORS PURGED (Y N) METHOD �� / I CL AMOUNT USED I S ( bS <br /> A 7 <br /> P L.E.L. READING AT REMOVAL (MUST BE < 208) <br /> 0 <br /> T R COMMENTS <br /> A <br /> NTANK MATERIA STEEL, IBERGLASS, OTHER) TANK SIZE ��0 <br /> KLN <br /> / TANK CONDITION (GOOD, POOR, OLES <br /> PI PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P IPIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G T DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> F A 7 2 6I <br /> I N <br /> E K <br /> L 4 �. <br /> D S- EXCAVATION SIZE: X X YDS OF SOIL : <br /> — <br /> I A DEPTH IL TYPE OBSERVATIONSAMPLE # <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 /> N2 DEPTH TO G.W. : — FT SAMPLING METHOD —— - <br /> 0 # OF HOURS SINCE DEWATERING: - <br /> 1O OTHER SAMPLE:L _-- <br /> LABORATORY: / SAMPLERS NAME: -- <br /> CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />