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S.jLHt1 - UNLEkGRUUNL 'TANK CLOSURE/A$ANDONMENT INSPECTION <br /> (SHADED ARE O BE FILLED IN FOR THE FI TANK ONLY) <br /> G OWNER NAME // OWNER PHONE # <br /> E �l �rnalr 4,C, <br /> N CONTRACTOR - CON. PHONE# _ ,y <br /> E Ccil� TruC <br /> v <br /> • C'� eco/a� <br /> R SJLHD, PERMIT # EPA yj FIRE PERMIT # <br /> A <br /> L <br /> INSPECTOR LIE DATE �� %� _ TANK # 39 <br /> R RINSED L'�/N) METHOD +�,.� �� RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED LlC/N) METHOD ; - AMOUNT USED <br /> A <br /> PL.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> o <br /> T R COMMENTS p'�' �wr. ISVI <br /> A <br /> N TANK MATERIAL (STEE;,) FIBERGLASS, OTHER) TANK SIZE <br /> K C <br /> / 0 TANK CONDITION (GOOD,� POOR,' HOLES) <br /> P N <br /> I JS PIPE MATERIA4-((STEEL\ FIBERGLASS, OTHER) # FEETJP <br /> I PIPING CONDITION (GOOD, POOR,, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A ' - =h7-1,- 14-- <br /> I <br /> /c1 -I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: & X X _,� ;� YDS OF SOIL: 7 S y C(S <br /> S- <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I <br /> P L P ! L--f <br /> E I E o :�ss �g�• F - <br /> C N <br /> T G TRENCH DIMENSION X �_ X YDSOF SOILS <br /> I 7s <br /> O H DEPTH TO G.W. : <br /> N <br /> FT SAMPLING METHOD l�rttiss � <br /> 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> FllOTHER SAMPLE: <br /> —T LABORATORY: /1%i'� ( �., SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> i <br /> DRAW SITE MAP ON REVERSE <br />