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��Ltf11 ~ UND4'NGRUUND TANK CLOSURE/A$ANDC .MENT INSPECT10N <br /> (SHADED A ' TO BE FILLED IN FOR THE RST TANK ONLY) <br /> Iwo <br /> G OWNER NAME OWNER PHONE # ' <br /> E <br /> N CONTRACTOR CON. PyONE# <br /> E �c'ir, C/ or, <br /> R { SJLHD PERMIT # �'''���'�"��y3 `l <br /> EPA p FIRE PERMIT # <br /> INSPECTOR L7 Ute, DATE s- <br /> TANK @ 3$ <br /> R RINSED (YIN) METHOD Sc�P RINSE AMOUNT <br /> I <br /> Pea l/P <br /> S RI NSATE DISPOSAL SITE <br /> E MANIFEST # -OR-- OTHER <br /> V VAPORS PURGED (YIN) METHOD <br /> A lill r AMOUNT USED <br /> /C� <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> -..•. .5[SEL r'1 tir;RGLAS S, OHER) TANK SIZE ZE 1> r <br /> :r <br /> `P <br /> K C 000 <br /> / 0 TANK CONDITION (GOOD, POOR, HOLES) <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE <br /> F A , -/ o,�/ - 00 9- <br /> I NLi <br /> s�.Q <br /> E K <br /> L <br /> D S- <br /> EXCAVATION SIZE: X X YDS OF SOIL: <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 XX <br /> X YDS OF SOIL <br /> O H DEPTH TO G.W. : FT <br /> - <br /> N SAMPLING METHOD <br /> 2 <br /> U I OF HOURS SINCE DEWATERING: <br /> OTHER SAMPLE: <br /> LABORATORY: (3 fq 1'4 La SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> Ell 23 043(7/88) DRAW SITE MAP ON REVERSE <br />