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SiLho - UiADEt1,GRUUND 'TANK CLOSURE/AAANDONMENT INSPECTION <br /> (SHADED ARI&TO BE FILLED IN FOR THE F&T TANK ONLY) <br /> G a OWNER NAME S/� OWNER PHONE # �T)'.7 <br /> E 6, <br /> N { CONTRACTORS CON. PHONE# <br /> E <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> A ; <br /> L _ <br /> INSPECTOR,,, � DATES ���" i�. TANK # 39 — — <br /> R RINSED (Y/N) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # —OR— OTHER <br /> V VAPORS PURGED (Y,./N) METHOD �U-�, AMOUNT USED/� i,C 0C� `� <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 (STEEL, FIBERGLASS, OTHER) T ��, <br /> ANK 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, POOR, HOLES ) � � ,_� <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> F A <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: 7 X X YDS OF SOIL- '/� �� <br /> S— <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <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 /> �O OTHER SAMPLE: <br /> LABORATORY: /-, SAMPLERS NAME:/y j,4,4, 434,12 <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> Lj <br /> DRAW SITE MAP ON REVERSE <br />