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Un 'ttG1(UU1V1) 'TANK CLOSURE/AI►AN' 'MENT INSPEC'11iUN <br /> (SHADED Jti A TO BE FILLED IN FOR THE ?FIRST TANK ONLY) <br /> G ; OWNER NAME OWNER PHONE p <br /> E /N 77 7 7 J <br /> N CONTRACTOR rpv CON. PHONEN ��p �23Z <br /> E 7 <br /> R J.Lyb PERMIT I EPA ICAD 0 1 C <br /> �12G FIRE PERMIT tl <br /> L . . . . <br /> 1%kINSPECTOR lb�� DATE I'M 1-1 TANK 1 39 <br /> R RINSED Y N) METHO lRINSE AMOUNT/ <br /> I <br /> N RINSATE DISPOSAL SITE v'C <br /> S <br /> E MANIFEST Y c 53 IZ -OR- OTHE? <br /> V VAPORS PURGED Y N) METHODI�j Q� AMOUNT USED �/5 <br /> A 21 <br /> P L.E.L. READING AT REMOVAL (MUST BE C 20%1 �C( i 6� 7� <br /> O J <br /> T R COMMENTS �0 <br /> A <br /> N TANK MATERIAL STEE , FIBERGLASS, 0?HER) TANK SIZE <br /> K C ID 6 <br /> / 0 TANK CONDITION (GOOD POOR, HOLES) Y)D <br /> P N nacx a f a <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) Y FEET A,10 <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G EPTOIL TY E OBSERV <br /> T TION SA # <br /> ' <br /> F A " 1 1, <br /> C0.S{ <br /> I N a- W - <br /> E K <br /> L <br /> D EXCAVATION SIZE: X X YDS OF SOIL:-�7S`)AS <br /> 3- <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. : FT SAMPLING METHOD <br /> N 2 �lrn <br /> 0 1 OF HOURS SINCE DEWATERING: �� <br /> aOTHER SAMPLE:_D1 SC4, tY� 03 LLL <br /> LABORATORY: SAMPLERS NAME y <br /> CLOSURE IN PLACE MIXTURE: � VOLUME• <br /> DRAW SITE MAP ON REVERSE <br />