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S.1LHt1 - Ur4bE UUND TANK CLOSURE/AAANDOVT <br /> NT INSPECTION <br /> (SHADED AREO BE FILLED IN FOR THE F TANK ONLY) <br /> Y <br /> G OWNER NAME �d• a °be= OWNER PHONE # 2,09 <br /> E ''-` <br /> E ,CONTRACTOR ' CON. PHONEy <br /> R < SJLHD PERMIT # [ EPA # FIRE PERMIT # <br /> A { <br /> L <br /> I NSPECTOR7 Frr ,o'�o DATE �r+ TANK # 39 - Z U <br /> R RINSED (Y/N) METHOD RINSE AMOUNT <br /> T <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR-- OTHER <br /> V VAPORS PURGED Y/N) METHOD'/ yL AMOUNT USED <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> O <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL.' TEELI FIBERGLASS, OTHER) TANK SIZE T) v( <br /> K C <br /> / 0 TANK CONDITION (/GO? POOR, HOLES) <br /> -- <br /> I S PIPE MATERIAL f(STE�F'IBERGLASS, OTHER) FA FEET <br /> P T <br /> I PIPING CONDITION (fGOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T { L t- t 11U or (�'Cf vhc- <br /> F A colocf I I 4 � <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: 7 X P5 X YDS OF SOIL: 0 < <br /> S- <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P O r4. o= - <br /> S P I <br /> P L P f _I ec <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION Ll 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 /> L_-LABORATORY: �� SAMPLERS NAME: (� j <br /> CLOSURE IN PLACE I MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />