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TANK CLOSURElAfAANr__VMENT INSPECTION <br /> !SHADED I YA TO BE FILLED IN FOR THE" 'RST TANK ONLY) <br /> �qn,- <br /> r <br /> G OWNER NAME OWNER PHONE # c <br /> E S�ivn.e� C oZo �) e.35- 6-3a n <br /> E f CDNTRACTOR�� C zL tG G[a CON,' PHONE# D 7 ;I' <br /> R s SJLHD PERMIT I EPA # i FIRE PERMIT b <br /> L � . � `�` <br /> ILINSPECTORY / PS DATE j i7 ITANK # 39 _773, a 3 _ 03 <br /> R RINSED (Y METHOD RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST I -`OR- OTHER - ! <br /> V VAPORS PURGED (Y N) METHOD " AMOUNT USED <br /> A _T <br /> PD L.E.L. READING AT REMOVAL (MUST Be < 20%) 1 c?.z n'1 <br /> T R COMMENTS <br /> i�—�fes". _ __ ..:- ,�P:�J`f /�PiL•H Crs�� , <br /> i i:Cv i. Vit11't_;tt i AL, ( STEEL, F I Bir RGL1i5 S," OTHER) TANK SIZE <br /> K C ' <br /> P/ N GOOD,TANK CONDITION POOR, HOLESI) S °�' g��rD Jr�� <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 SAMPLE # <br /> T <br /> F A - <br /> I N a ff <br /> E K <br /> L <br /> D EXCAVATION SIZE: b X Xk YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION S MPLE # <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+ YDS OF SOIL <br /> I °= <br /> ' O H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 N OF HOURS SINCE DEWATERING: <br /> OTHER SAMPLE: <br /> LABORATORY: � i SAMPLERS 'NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br /> Ell 23 013(7/88) <br /> ' l it <br />