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SJLHDRGRUUND 'TANK CLOSURE/A1)AONMENT 1NSPECTI UN <br />(SHADED TiftEA TO DE FILLED IN FOR THE FIRST TANK ONLY) <br />DRAW SITE. MAP ON REVERSE <br />Amts el-j-zc -3*Zje i/!w <br />rS 7-lir.2 0,1U - <br />L <br />G iOWNER NAME Alt -w -D G. <br />-� <br />OWNER PHONE p y61 V-31 7/ <br />E um a <br />N <br />< CONTRACTO GCJAI�liGll /J�irre�� <br />' <br />.f t� <br />CON. PHONE# <br />E <br />R <br />SJLHD ERMIT p EPA FII�1RE PERMIT p <br />A <br />1pC%A000p170.6 <br />d RE <br />i����I <br />L <br />' f����1i��Dft � <br />INSPECTOR Gtro�w DATE TANK p 39 S <br />R <br />RINSED (®N) METHOD �OH55&t IL76-te RINSE AMOUNT <br />I <br />c <br />N <br />S <br />RINSATE DISPOSAL SITE /eaymos 6)i/4pcyc%+-°� �s�y-S,iP�-v: 'j � acy� <br />E <br />MANIFEST p �_ -OR- OTHER recle"f * cwzz <br />V <br />VAPORS PURGED (PN) <br />METHOD dry <br />AMOUNT USED ys0 /bs, <br />A <br />L.E.L. READING AT REMOVAL (MUST BE < 20%) <br />P <br />0 <br />T <br />R <br />COMMENTS <br />A <br />N <br />TANK MATERIAL STEEL FIBERGLASS, OTHER) <br />TANK SIZE <br />K <br />C <br />TANK CONDITION((GOOD POOR, HOLES) <br />/ <br />0 <br />P <br />N <br />PIPE MATERIA STEE , FIBERGLASS, OTHER) <br />p FEET 7 D <br />I <br />"P <br />S <br />T <br />PIPING CONDITION((GOOD POOR, HOLES) <br />I <br />N <br />G <br />DEPTH <br />SOIL TYPE <br />OBSERVATION <br />SAMPLE p <br />T <br />� , <br />I <br />N <br />E <br />K <br />L <br />D <br />S- <br />EXCAVATION SIZE: X ,90' X <br />— <br />YDS OF SOIL: Y� <br />I <br />A <br />DEPTH SOIL TYPE <br />OBSERVATION <br />SAMPLE p <br />N <br />M <br />P <br />S <br />P <br />I <br />P <br />L <br />P <br />E <br />I <br />E <br />C <br />N <br />T <br />G <br />TRENCH DIMENSION X X <br />YDS OF SOIL <br />I <br />' — <br />DEPTH TO C.W.: FT <br />SAMPLING METHOD <br />0 <br />H <br />N <br />2 <br />0 <br />1 OF HOURS SINCE DEWATERING: <br />0 <br />OTHER SAMPLE: <br />Lh80RATORY: C.Qnpl7ie LGi�IS - <br />SAMPLERS NAME: Sce-j <br />CLOSURE IN PLACE <br />I MIXTURE: VOLUME: <br />DRAW SITE. MAP ON REVERSE <br />