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SiLHO - UNDEd UUND TANK CLOSURE/A4AND0N T INSPECTION <br /> (SHADED AREO BE FILLED IN FOR THE FrW TANK ONLY) <br /> 5l Illf } <br /> G OWNER NAME; = '`�` r. , dlz � OWNER PHONE <br /> N CONTRACTORI CCON. PHONE#E Lc Ol. <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> A . . . . <br /> L <br /> INSPECTOR �'A4ri DATE f , �-, �K # 39 — h_ -- <br /> R RINSED (YIN) METHOD RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # —OR— OTHER <br /> V VAPORS PURGED (YIN) METHOD / C AMOUNT USED h �� <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE C 20%) <br /> 0 <br /> T R COMMENTS <br /> A _ <br /> N TANK MATERIAL. i('S-TEFL, FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD, (-'POOR,) _�OLE ) <br /> P N <br /> I SPIPE MATERIAL , STEL` , FIBERGLASS, OTHER) # FEET E7 <br /> P T c� <br /> I PIPING CONDITION (GOOD, `POOR.- 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 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 /> 00 # OF HOURS SINCE DEWATERING: <br /> El <br /> OTHER SAMPLE: <br /> LABORATORY: F-C L SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />