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�OLNu - UNV 'KGHUUND 'DANK CLOSUREJAB,AND' MENT INSPECTIUN <br /> (SHADED All, TO BE FILLED IN FOR THE r.eRST TANK ONLY) <br /> G OWNER NAME <br /> E �:a to /�� OWNER PHONE # <br /> a a � <br /> N CONTRACTOR CON. PHONE# <br /> E <br /> Q N C ECoi�� Y3 <br /> R < SJLHD ERMIT # EPA # FIRE PERMIT # <br /> INSPECTOR Ll �` DATE TANK # 39 - q - nom <br /> R RINSED (Y/N) METHOD Scup RINSE AMOUNT <br /> I B a�(�e�/P <br /> N RINSATE DISPOSAL SITE <br /> S A//Pd P <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y/N) METHOD � � AMOUNT USED <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> O <br /> T R COMMENTS <br /> K C STEEL r'iBERGLASS, OTHER) TANK SIZE 3 oo D <br /> O <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES) d <br /> P N <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 ✓ oc/ Od <br /> I N ' - -p <br /> E K <br /> L <br /> D EXCAVATION SIZE: XX YDS OF SOIL : <br /> S- — <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 /> Z — <br /> O H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: <br /> LABORATORY: A 60"-/'q' z SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> 1:11 23 043(7/88) DRAW SITE MAP ON REVERSE <br />