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JvLnL - UN? 'GKUUND TANK CLOSURE/ABAND' MENT INSPECTION <br /> (SHADED Al\=d TO BE FILLED IN FOR THE TANK ONLY) <br /> G OWNER NAME_S OWNER PHONE # zo c �'3i <br /> E <br /> ECONTRACTOR � C CON. PHONE# <br /> R < SJLHD PERMIT # �� EPA # FIRE PERMIT # <br /> L � � <br /> INSPECTOR J DATE �{-�� z �ITANti,.��39 <br /> - co - Oy <br /> R RINSED (Y N) METHOD RINSE AMOUNT <br /> . I <br /> N DISPOSAL SI 2 f <br /> S <br /> E MANIFEST -OR- OTHER <br /> V VAPORS PURGED (Y ) METHOD'1-,,(_` C� AMOUNT USED -72CA <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> O L ;��/6 <br /> T R COMMENTS ,(CY <br /> 14 A JL_ <br /> K C TANK MATERIAL (STEEL-- IBERGLASS, OTHER) TANK SIZE �u *� <br /> / cqA <br /> 0 TANK CONDITION (GO OOR, HOLES)P N y� <br /> I S PIPE MATERIA STEEL FIBERGLASS, OTHER) # FEET <br /> P T _ <br /> I PIPING CONDITION (GOOD, OOR, HOLES) <br /> N <br /> G T DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> F A -fes v� 7 )S dlcec � rcl <br /> I N <br /> E K <br /> L �Z - <br /> D S-_ EXCAVATION SIZE: X X } YDS OF SOIL: VS <br /> I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I CLAq <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I f may, T�1� <br /> O H DEPTH TO G.W. : NE FT SAMPLING METHOD - <br /> N 2 <br /> 0 0 OF HOURS SINCE DEWATERING: <br /> OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: - <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> LI[ 23 0,13(7/88) DRAW SITE MAP ON REVERSE <br />