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PHS-EHD - UNDERGROL_ ) TANK CLOSURE/ABANDONMENT-fNSPEC1-101V <br /> (SHADED AREA <br /> T�OB(/yE FILLED IN 'FOR THE FIRST TANK/ ONLY) <br /> ' ,..` •%%I//'� %L%J%�/%�/////J/'�TI/J/.. H .u ll U K t /�/ /lee <br /> E OWNER NAME I Iti OWNER PHONE # �) <br /> N CONTRACTOR I l_ CON. PHONE# /�_ � <br /> E I CCJ 1L4 _ <br /> R SJLHD PERMIT # EPA #CAGocap FIRE PERMIT # 1zCl } <br /> A =� <br /> 119L <br /> I NSPECTOR9, F&-,By DATE TANK # 39 <br /> R RINSED METHOD � rpie K <br /> I ln,5- RINSE AMOUNTS T-ongL <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFEST # -OR- OTHER _ <br /> V VAPORS PURGED (Y/N) METHOD-Z>Ry jr-6 AMOUNT USED �Q IbS <br /> A <br /> P L. E. L. READING AT REMOVAL (MUST BE ( 20%) -,e- <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL ( TEEL FIBERGLASS, OTHER) TANK SIZE <br /> K C (S00CJ /� <br /> � C-.rn <br /> / 0 TANK CONDITION (GOOD, OOR HOLES) CoRRos(o nl <br /> N <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET nO PI,10I ._J <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE # <br /> F A _ in o <br /> _ <br /> I N # <br /> E K -r <br /> L <br /> D S EXCAVATION SIZE: 15 X 12. X YDS OF SOIL: <br /> IA DEPTH SOIL TYPE SERVATION AMPLE <br /> N M P <br /> S F' T <br /> P I' F <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X YDS OF SOIL <br /> I -- <br /> 0H DEPTH TO G. <br /> N W. :ecOpy rn�r1 FT SAMF'LING METHOD - <br /> 0 # OF HOURS SINCE DEWATERING:L � <br /> 0❑ OTHER SAMPLE: -&� <br /> LABORATORY: �-(o tP-ZEt, l eNV. ENG- SAMPLERS NAME:$RIAN µNC-v _ <br /> CLOSURE IN PLACE MIXTURE: Ki 1A VOLUME: F11A <br /> EH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />