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6"-MU — UriU`'KUhUUNU 'TANK CLUSURE/AB,ANDONMEmT 114SPECTIUN <br /> (SHADED A.—i TO BE FILLED IN FOR THE RST TANK ONLY) <br /> �11Nr. I 'll. . . . . . ... <br /> CL ti <br /> G OWNER NAME C P�. l C` OWNER PHONE # 2 6, <br /> E l <br /> N < CONTRACTORS Y� Con iYC C.}14 CON. PHONE# 2 U C� L4 (e7 , <br /> E <br /> R < SJLHD PERMIT # EPA #` ''' FIRE PERMIT # I <br /> L _I'll 4 / N �. <br /> INSPECTOR ' . Lk.,GC iui DATE TANK # 39 <br /> R RINSED (//N) METHOD RINSE AMOUNT jbc4� <br /> I <br /> N RINSATE DISPOSAL SITE ��'� <br /> S <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGEDMETHOD�j j r� AMOUNT USEDIG� _ <br /> A µn <br /> P L.E. L . READING AT REMOVAL (MUST BE < 20$) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL (STEEL, FIBERGLASS, OTHER ) TANK SIZE (S� <br /> K C <br /> / 0 TANK CONDITION (GOOD, (POOR, HOLES) <br /> P N <br /> I S PIPE MATERIAL (STEE , FIBERGLASS, OTHER) # FEET O e <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES ) j�QV4Y UbSefVpC� <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> F A <br /> lU r6oc 9(-cjtw-, ' <br /> I N <br /> E K <br /> L <br /> D EXCAVATION SIZE: ILL X L X 1( YDS OF SOIL: L.) LJ <br /> S <br /> 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 XX YDS OF SOIL <br /> I <br /> 0 H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> ❑O OTHER SAMPLE: <br /> LABORATORY: T' - SAMPLERS NAME: 7c i <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE MAP ON REVERSE <br />