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'k <br /> UNDERGROUND 'TANK CLOSURVA14ANDONMENT IN51q:(:,T1UN <br /> ,(SHADED AREA TO BE FILLED IN FOR THE FIRST TANK ONLY) <br /> G OWNER NAME <br /> E OWNER ['HONE q <br /> N CONTRACTOR <br /> E CON. PHONEN . <br /> R ; SJLHD PERMIT I EPA R <br /> FIRE PERMIT a <br /> -, . <br /> ` PER <br /> INSPECTOR <br /> l y <br /> � DATE TANK 1 39 <br /> R RINSED Y%N) METHOD . �� t r-� <br /> I / RINSE AMOUNTp�� nt <br /> N RINSATE DISPOSAL SITE <br /> S <br /> E MANIFUT -OR- OTHER <br /> V VAPORS PURGED <br /> L.7 i METHOD 1 <br /> A04' / AMOUNT USED <br /> P L.E.L. READING AT REMOVAL (MUST BE t 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> N TANK MATERIAL STE9, FIBERGLASS, O <br /> K C THERi TANK SIZE <br /> / 0 TANK CONDITION (GOOD, P OEC, HOLES) <br /> P N <br /> ' I S PIPE MATERIALT E I, FIBERGLASS, <br /> P T OTHER) FEET <br /> ` <br /> I <br /> N PIPING CONDITION (GOOD, POOR` HOLES) , <br /> G DEPTH SOIL TYPE OBSERVATION <br /> T SAMPLE II <br /> F <br /> I A <br /> N <br /> E K . , <br /> L <br /> D EXCAVATION SIZE: X X <br /> S; 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 /> I G TRFNCH DIMENSION <br /> --- X — X f YDS OF SOIL <br /> Q H DEPTH TO C.W. : <br /> N 2 ------� SAMPLING METHOD <br /> ('�0 1 OF HOURS SINCE DEWATERING: <br /> 0 J OTHER SAMPLE: <br /> E <br /> LABORATORY; .,v;, svr''clr ..4cf .Leib <br /> .. � -� SAMPLERS NAME <br /> C 1<l' ' NAME: (-/,I-( s <br /> CLOSURE IN PLACE MIXTURE:• <br /> VOLUME: <br />