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Ujj 'GL<UU14V 'TANK CLOSURE/ABLANI MENT INSPECTION <br /> (SHADED Ay TO BE FILLED IN FOR THE ;RST TANK ONLY) <br /> 41 <br /> G OWNER NAME OWNER PHONE # '" <br /> E <br /> N CONTRACTOR CON. PHONE# <br /> E <br /> R t SJLHD PERMIT # EPA # FIRE PERMIT # <br /> INSPECTOR b DATE TANK # 39 <br /> R RINSED (Y N)l METHOD, RINSE AMOUNT <br /> I <br /> N RINSATE DISPOSAL SITE Q-- <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED (Y/ ) METHOD r ( C� AMOUNT USED <br /> A <br /> P L.E.L. READING AT REMOVAL (MUST BE < 20%) �- <br /> 0 J <br /> T R COMMENTS - <br /> A <br /> N TANK MATERIAL (STEEL FIBERGLASS, OTHER) TANK SIZE --�-LL <br /> K C <br /> / 0 TANK CONDITION �- <br /> (GO POOR, OLES) -e'A d� k <br /> P N <br /> I S PIPE MATERIAL TEE , FIBERGLASS, OTHER) # FEET P'P'r <br /> P T <br /> I PIPING CONDITION (GOOD, OOR, )HOLES) C-4D-y-F05J Com` &V tc� <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A <br /> I N <br /> E K <br /> L <br /> D S- EXCAVATION SIZE: X X YDS OF SOIL: <br /> _ <br /> I I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X <br /> I YDS OF SOIL <br /> N <br /> O H DEPTH TO G.W. : -- FT SAMPLING METHOD <br /> 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> OTHER SAMPLE: -- <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: _ VOLUME: <br /> LII 23 0,13(7/88) DRAW SITE MAP ON REVERSE <br />