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SJLHU UUNU TANK CLOSUHI j A4ANr 'I NT INSvECTI UN <br /> (SHADED A%" TO BE FILLED;, IN FORt Tlll: �l<ST TANK ONLY) <br /> f � = � , <br /> G OWNER NAME OWNER PHONE I lcir, <br /> N CONTRACTOR iyl � } CON. j} PHONE l ' <br /> i. E <br /> R SJLHD P11 ERMIT 0 EPA f !IFIRE PERMIT # <br /> LCL <br /> � � � � }` <br /> INSPECTOR�j DATE �`�' TANK j� A 39 <br /> i # <br /> R RINSED &N) METHOD RINSE AMOUNT <br /> I / <br /> N RINSATE DISPOSAL SITE I k <br /> S <br /> E MANIFEST # —OR— 110THER I <br /> V VAPORS PURGED Y N) METHOD � AMOUNT USED j <br /> A u <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> O „ :t " <br /> T R COMMENTS j I <br /> A <br /> N TANK MATERIAL {STE IBERGLASS,.j�OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITI O {GOOD, OOR HOLES) - <br /> P N <br /> I S PIPE MATERIA , FIBERGLASS, JJOTHER) FEET <br /> P T <br /> I PIPING CONDIT 0 OOD, POOR, HOLES) � . <br /> N ,# <br /> G DEPTH SOIL TYPE OBSERVATION i � SAMPLE 0 <br /> T p_1 aj, <br /> F A �' <br /> I NIjI <br /> �] <br /> I <br /> E <br /> L <br /> D EXCAVATION SIZE: X X ;� YDS OF SOIL: 27 <br /> S- <br /> I A DEPTH SOIL T OBSERVATION SAMPLE t <br /> N M P <br /> IK S P I 44 <br /> P L P 0 k <br /> C N <br /> M <br /> T G TRENCH DIMENSION X X ij YDS OF SOIL <br />. I <br /> O H DEPTH TO G.W. : k FT SAMPLING METHOD <br /> N 2r <br /> 0 0 OF HOURS SINCE DEWATERING: I j <br /> OTHER SAMPLE: <br /> f <br /> F LABORATORY: <br /> FSAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: E a b VOLUME: <br /> DRAW SITE ' <br /> MAP ON REVERSE <br /> E?II 2:1 0,1:1(7/88) <br />