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5.►l,liu - UAbEXGHUUNU TANK CLOSURE/AIJANDONMF,NT INSPECTION <br /> (SHADED ARMh TO BE FILLED IN FOR THE ST TANK ONLY) <br /> t <br /> '1G4r� Ccs S��-v• rc rc,l)�r-nag <br /> Clot t Nom,. 1 �� [lA cu" <br /> GOWNER NAME <br /> E f 4? ` ('C I1> _ OWNER PHONE 2-0q Ll LiS�1 <br /> N < CONTRACTOR CON. PHONE# <br /> E ��fc i S 1 do 1,)C�1 (is4m� S 2-0 ck, ,-I 2- <br /> R SJLHD PERMIT # <br /> EPA I FIRE PERMIT # <br /> A , <br /> L <br /> R RINSED (Y METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED YEN) METHOD AMOUNT USED <br /> A Yl _I . <br /> P L.E.L. READING AT REMOVAL (MUST BE C 20%) ldrl ��Lf <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL. (STEEL`, FIBERGLASS, OTHER) TANK SIZE 1 <br /> K C <br /> / 0 TANK CONDrTION'TGOOD POOR, HOLES) (, �'C( , (lcl{, c4 <br /> P N L'<_ l <br /> I S PIPE MATERIAL <br /> P T STEEL;' FIBERGLASS, OTHER) # FEET <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE <br /> T <br /> F A v 0a -t Ji tt <br /> I N 5 nC[ E_ C ,r,f cl, 0, 14 2, 14 !1 1_ v - 3 <br /> E K rai a�avu�t k- ,cCc1v �1. r f�1r{ pili it <br /> D EXCAVATION SIZE: X E }- X <br /> S- <br /> 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. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> L—oil OTHER SAMPLE: <br /> LABORATORY: 1lV i V1 1 rt C SAMPLERS NAME: <br /> CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />