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RGROUND TANK CLOSURE/nTsE r=te*T TANK ONL / : <br /> uNDE IN FOR F: <br /> siLHu — _.TO BE 'FILLED <br /> {SHADED AREk <br /> ` OWNER PHONE <br /> G -OWNER NAME •5 PHONE# <br /> E CON. ; <br /> CTOR # <br /> N { CONTRA 1,f FIRE <br /> E EPA # PERMIT A <br /> R ; SJLHD PERMIT # ��. <br /> • <br /> A fi — <br /> L <br /> TANK # <br /> DATE ,I b/ U, S�± <br /> INSPECTOR RINSE AMOUNT <br /> METHOD ` <br /> R RINSED (y/ !! T <br /> I - <br /> N RINSATE DISPOfSAL SITE <br /> S ` —OR— OTHER <br /> E MANIFEST # <br /> AMOUNT USED " E <br /> V VAPORS PURGED (Y/ ) METHOD x _. �� + <br /> A < 2S$]h ; <br /> P L.E.I,. READING AT REMOVAL (MUST BE c7 <br /> O ,.. <br /> s T R COMMENTS ' <br /> A <br /> N TANK MATERIAL. { STEEL, FIBERGLASS, OTHER) TANKV�SIZE��� <br /> i K O TANK CONDITION (GOOD, POOR HOLES ) <br /> P N <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER). I FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR,, HOLES ) <br /> NSAMPLE # <br /> G DEPTH �rSOIL TYPE OBSERVATION <br /> T `1 i� tib— r1 <br /> F A <br /> 4- ;{ <br /> I N i.7r <br /> E <br /> D EXCAVATION SIZE: X X YDS OF SOIL: ~ r, <br /> I S L <br /> I A EPTH OIL TYPE BSERVATIONAMPLE <br /> N M P ,� <br /> f� P L P sir; • . - s \.. <br /> ` E I E <br /> C N <br /> T G TRENCH' DIMENSION X —X YDS OF SOIL- <br /> 0 H DEPTH TO G.W. : A.67u e4lLovev wcj SAMPLING METHOD <br /> N 2 <br /> a I OF HOURS. SINCE DEWATERING: <br /> O OTHER SAMPLE: <br /> LABORATORY:, - M --�_ - SAMPLERS NAME: -- <br /> CLOSURE IN PLACE MIXTURE: x .., a, ��_ VOLUME: <br /> ,DRAW SITE HAP, ON REVERSE <br />