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u — U, ,ROUND TANK CLOSURE/Ai{ANDONMENT INSPLs i1UN <br /> (SHADED AR EP TO BE FILLED IN FOR THEFIW TANK ONLY) <br /> ff TV SWIM <br /> G < OWNER NAME �l � OWNER PHONE # <br /> E <br /> N < CONTRACTOR �n /�✓ CON. PHONE# <br /> E <br /> R < SJLHD PERMIT # EPA # FIRE PERMIT # <br /> L <br /> INSPECTOR / I ��� DATE�U 7 �� TANK # 39 - � <br /> f <br /> R RINSED WIN) METHODCRINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y/ ) METHOD '� AMOUNT USED�I <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEELP FIBERGLASS, OTHER) TANK SIZE-� <br /> K C <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES ) <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (:-(GOOD, P60R, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A —�-- <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: X _ X YDS OF SOIL: <br /> S- <br /> I ADEPTH 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 /> 0H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE NAP ON REVERSE <br /> Ell 23 043(7/88) <br />