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• ..i.nv — UNIAWGIcuuAD TANK CLOSURE/ABAND#VkMENT INSPECTION <br /> (SHADED A; TO BE FILLED IN FOR THEST TANK ONLY) <br /> 1 <br /> G OWNER NAME <br /> OWNER PHONE # <br /> E <br /> N CONTRACTOR <br /> E CON. PHONE# <br /> R i SJ D PERMIT # EPA # FIRE PERMIT # <br /> L �'� ` <br /> INSPECTOR DATE _( Z_g TANK # 39 — CO — t <br /> R RINSED ( N) METHODRINSE AMOUNT �� <br /> I <br /> N RINSATE DI OSAL SITE <br /> S <br /> E MANIFEST # —OR— <br /> OTHER <br /> AV VAPORS PURGED (Y N) METHOD rL J Ge,_ AMOUNT USED <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N AdK MATERIAL (STEEL, FIBERGLASS, <br /> K C OTHER) TANK SIZE <br /> / 0 TANK CONDITION -H POOR, HOLES <br /> P N <br /> I S PIPE MATERI <br /> P T (STEEL, FIBERGLASS, OTHER) # FEET 121PJ �`J <br /> I PIPING CONDITION (GOOD, OOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A <br /> I N <br /> E K <br /> L <br /> S- EXCAVATION SIZE: ip X X (I YDS OF SOIL: <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 X YDS OF SOIL <br /> I <br /> 0 H DEPTH TO G.W. : FT <br /> N 2 SAMPLING METHOD <br /> 0 # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> Ell 23 0-13(7/88) DRAW SITE MAP ON REVERSE <br />