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nvv"U TANK E A$ANDONMENT INSPECTION <br /> (SHADED AR1 TD BE FILLED IN FOR THE .' ST TANK ONLY) <br /> I ZO <br /> G OWNER NAME <br /> E P OWNER PHONE # <br /> N CONTRACTOR,SE C� kr_H CON. PHONE# C7N)Jr Z'�-q X53 <br /> E <br /> R SJLHD PERMIT # EPA # FIRE PERMIT # <br /> A ' I <br /> L <br /> INSPECTOR VC- DATEIZ SV TANK # 39 - i �Q - <br /> y <br /> RINSED Y N) METHOD`i�KIi�LC I r�S2- RINSE AMOUNT <br /> I ;j <br /> N RINSATE DISPOSAL SITE P.�jJ � <br /> S <br /> E MANIFEST # <br /> -OR- OTHER <br /> V FVAPORS PURGED (Y N) " METHOD .AMOUNT USED �� _ <br /> A I IC(� <br /> A L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS �r <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER) TANK SIZEIO <br /> K C , OO Z.G <br /> ` <br /> 0 TANK CONDITION00 ; POOR, HOLES) <br /> N <br /> I S PIPE HATER IAL,t(STEE 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 Z A <br /> I N <br /> r, s <br /> E1 �ff `' " <br /> K �+ rr <br /> L <br /> D EXCAVATION SIZE: XIX <br /> 3- YDS OF SOIL: <br /> " <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M p SAMPLE # <br /> S p I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X <br /> I OF SOIL <br /> O H DEPTH TO G.W. : bsrupr T SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: �= <br /> i <br /> LABORATORY: SAMPLERS NAME <br /> CLOSURE IN PLACE MIXTURE: VOLUME: r-- <br /> DRAY S I T8 KAP ON RSVBRSS v... <br />